A surgical system includes a surgical instrument, an end effector, a control circuit, and a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The control circuit is configured to adjust a closure rate of change parameter and the closure threshold parameter based on perioperative information received from one or more data sources and a sensor signal received from the sensor.
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23. A surgical instrument, comprising:
an end effector comprising:
a first jaw; and
a second jaw, wherein the first jaw is configured to move relative to the second jaw;
a motor configured to move the first jaw relative to the second jaw according to a first closure control program received from a surgical hub; and
a sensor configured to sense a closure parameter of the end effector; and
a control circuit communicatively coupled to the sensor and the motor, wherein the control circuit is configured to:
receive the closure parameter from the sensor; and
select a second closure control program, different than the first closure control program, based on perioperative information and the closure parameter of the end effector.
21. A surgical system, comprising:
a surgical instrument, comprising:
an end effector comprising:
a first jaw; and
a second jaw, wherein the first jaw is configured to move relative to the second jaw;
a motor configured to move the first jaw relative to the second jaw according to a first closure control program; and
a sensor configured to sense a closure parameter of the end effector; and
a control circuit communicatively coupled to the sensor, wherein the control circuit is configured to:
receive perioperative information;
interrogate the sensor to determine the closure parameter of the end effector; and
select a second closure control program, different than the first closure control program, based on the perioperative information and the closure parameter of the end effector.
15. A surgical instrument comprising:
an end effector comprising:
a first jaw; and
a second jaw, wherein the first jaw is configured to move relative to the second jaw;
a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a first closure control program received from a surgical hub;
a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector; and
a control circuit communicatively coupled to the sensor and the motor, wherein the control circuit is configured to:
receive the sensor signal from the sensor; and
determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on perioperative information and the sensor signal.
1. A surgical system comprising:
a surgical instrument, wherein the surgical instrument comprises:
an end effector comprising:
a first jaw; and
a second jaw, wherein the first jaw is configured to move relative to the second jaw;
a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter; and
a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector; and
a control circuit communicatively coupled to the sensor, wherein the control circuit is configured to:
receive perioperative information, wherein the perioperative information comprises one or more of a perioperative disease, a perioperative treatment, and a type of a surgical procedure;
receive the sensor signal from the sensor; and
determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.
22. A surgical system, comprising:
a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system, wherein the surgical hub is communicatively coupled to the cloud computing system; and
a surgical instrument communicatively coupled to the surgical hub, wherein the surgical instrument comprises:
an end effector comprising:
a first jaw; and
a second jaw, wherein the first jaw is configured to move relative to the second jaw;
a motor configured to move the first jaw relative to the second jaw according to a first closure control program received from the surgical hub; and
a sensor configured to sense a closure parameter of the end effector; and
wherein the surgical hub is further configured to:
interrogate the sensor to determine the closure parameter of the end effector; and
select a second closure control program, different than the first closure control program, based on the perioperative information and the closure parameter of the end effector.
8. A surgical system comprising:
a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system, wherein the surgical hub is communicatively coupled to the cloud computing system; and
a surgical instrument communicatively coupled to the surgical hub, wherein the surgical instrument comprises:
an end effector comprising:
a first jaw; and
a second jaw, wherein the first jaw is configured to move relative to the second jaw;
a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a closure control program received from the surgical hub; and
a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector; and
wherein the surgical hub is further configured to:
receive the sensor signal from the sensor; and
determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.
2. The surgical system of
3. The surgical system of
4. The surgical system of
5. The surgical system of
6. The surgical system of
7. The surgical system of
the closure threshold parameter is a maximum closure force threshold; and
the control circuit is further configured to disable the motor for a predetermined period of time based on reaching the maximum closure force threshold.
9. The surgical system of
the closure control program is a first closure control program;
the surgical hub is further configured to transmit a second closure control program to the surgical instrument; and
the second closure control program defines the adjustment to the closure rate of change parameter and the adjustment to the closure threshold parameter.
10. The surgical system of
the cloud computing system is configured to transmit the second closure control program to the surgical hub; and
the adjustment to the closure rate of change parameter and the adjustment to the closure threshold parameter of the second closure control program is adjusted based on the perioperative information.
11. The surgical system of
12. The surgical system of
13. The surgical system of
the closure threshold parameter is a maximum closure force threshold; and
the surgical hub is further configured to disable the motor for a predetermined period of time based on reaching the maximum closure force threshold.
14. The surgical system of
16. The surgical instrument of
17. The surgical instrument of
switch from the first closure control program to a second closure control program received from a cloud computing system; and
change a speed of the motor based on the second closure control program.
18. The surgical instrument of
19. The surgical instrument of
20. The surgical instrument of
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This application claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 62/691,227, titled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS, filed Jun. 28, 2018, the disclosure of which is herein incorporated by reference in its entirety.
This application claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 62/650,887, titled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed Mar. 30, 2018, to U.S. Provisional Patent Application Ser. No. 62/650,877, titled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS, filed Mar. 30, 2018, to U.S. Provisional Patent Application Ser. No. 62/650,882, titled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed Mar. 30, 2018, and to U.S. Provisional Patent Application Ser. No. 62/650,898, titled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, filed Mar. 30, 2018, the disclosure of each of which is herein incorporated by reference in its entirety.
This application also claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 62/640,417, titled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed Mar. 8, 2018, and to Provisional Patent Application Ser. No. 62/640,415, titled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR, filed Mar. 8, 2018, the disclosure of each of which is herein incorporated by reference in its entirety.
This application also claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, to U.S. Provisional Patent Application Ser. No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, and to U.S. Provisional Patent Application Ser. No. 62/611,339, titled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of each of which is herein incorporated by reference in its entirety.
The present disclosure relates to various surgical systems.
A surgical system comprises a surgical instrument. The surgical instrument comprises an end effector comprising a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The surgical instrument further comprises a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter. The surgical instrument further comprises a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical system further comprises a control circuit communicatively coupled to the sensor. The control circuit is configured to receive perioperative information, wherein the perioperative information comprises one or more of a perioperative disease, a perioperative treatment, and a type of a surgical procedure. The control circuit is further configured to receive the sensor signal from the sensor and determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.
A surgical system comprises a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system. The surgical hub is communicatively coupled to the cloud computing system. The surgical system further comprises a surgical instrument communicatively coupled to the surgical hub. The surgical instrument comprises an end effector comprising a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The end effector further comprises a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a closure control program received from the surgical hub. The end effector further comprises a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical hub is further configured to receive the sensor signal from the sensor and determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.
The features of various aspects are set forth with particularity in the appended claims. The various aspects, however, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings as follows.
Applicant of the present application owns the following U.S. patent applications, filed on Jun. 29, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. Provisional Patent Applications, filed on Jun. 28, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. patent applications, filed on Mar. 29, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. patent applications, filed on Mar. 29, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. patent applications, filed on Mar. 29, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. Provisional Patent Applications, filed on Mar. 28, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. Provisional Patent Application, filed on Apr. 19, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. Provisional Patent Applications, filed on Mar. 30, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. Provisional Patent Applications, filed on Mar. 8, 2018, the disclosure of each of which is herein incorporated by reference in its entirety:
Applicant of the present application owns the following U.S. Provisional Patent Applications, filed on Dec. 28, 2017, the disclosure of each of which is herein incorporated by reference in its entirety:
Before explaining various aspects of surgical devices and generators in detail, it should be noted that the illustrative examples are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and are not for the purpose of limitation thereof. Also, it will be appreciated that one or more of the following-described aspects, expressions of aspects, and/or examples, can be combined with any one or more of the other following-described aspects, expressions of aspects and/or examples.
Certain exemplary aspects will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these aspects are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary aspects and that the scope of the various aspects is defined solely by the claims. The features illustrated or described in connection with one exemplary aspect may be combined with the features of other aspects. Such modifications and variations are intended to be included within the scope of the claims.
Referring to
Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical tools that are suitable for use with the present disclosure are described in U.S. Provisional Patent Application Ser. No. 62/611,339, titled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety.
Various examples of cloud-based analytics that are performed by the cloud 104, and are suitable for use with the present disclosure, are described in U.S. Provisional Patent Application Ser. No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety.
In various aspects, the imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, Charge-Coupled Device (CCD) sensors and Complementary Metal-Oxide Semiconductor (CMOS) sensors.
The optical components of the imaging device 124 may include one or more illumination sources and/or one or more lenses. The one or more illumination sources may be directed to illuminate portions of the surgical field. The one or more image sensors may receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and/or surgical instruments.
The one or more illumination sources may be configured to radiate electromagnetic energy in the visible spectrum as well as the invisible spectrum. The visible spectrum, sometimes referred to as the optical spectrum or luminous spectrum, is that portion of the electromagnetic spectrum that is visible to (i.e., can be detected by) the human eye and may be referred to as visible light or simply light. A typical human eye will respond to wavelengths in air that are from about 380 nm to about 750 nm.
The invisible spectrum (i.e., the non-luminous spectrum) is that portion of the electromagnetic spectrum that lies below and above the visible spectrum (i.e., wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the red visible spectrum, and they become invisible infrared (IR), microwave, and radio electromagnetic radiation. Wavelengths less than about 380 nm are shorter than the violet spectrum, and they become invisible ultraviolet, x-ray, and gamma ray electromagnetic radiation.
In various aspects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present disclosure include, but not limited to, an arthroscope, angioscope, bronchoscope, choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope, sigmoidoscope, thoracoscope, and ureteroscope.
In one aspect, the imaging device employs multi-spectrum monitoring to discriminate topography and underlying structures. A multi-spectral image is one that captures image data within specific wavelength ranges across the electromagnetic spectrum. The wavelengths may be separated by filters or by the use of instruments that are sensitive to particular wavelengths, including light from frequencies beyond the visible light range, e.g., IR and ultraviolet. Spectral imaging can allow extraction of additional information the human eye fails to capture with its receptors for red, green, and blue. The use of multi-spectral imaging is described in greater detail under the heading “Advanced Imaging Acquisition Module” in U.S. Provisional Patent Application Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein incorporated by reference in its entirety. Multi-spectrum monitoring can be a useful tool in relocating a surgical field after a surgical task is completed to perform one or more of the previously described tests on the treated tissue.
It is axiomatic that strict sterilization of the operating room and surgical equipment is required during any surgery. The strict hygiene and sterilization conditions required in a “surgical theater,” i.e., an operating or treatment room, necessitate the highest possible sterility of all medical devices and equipment. Part of that sterilization process is the need to sterilize anything that comes in contact with the patient or penetrates the sterile field, including the imaging device 124 and its attachments and components. It will be appreciated that the sterile field may be considered a specified area, such as within a tray or on a sterile towel, that is considered free of microorganisms, or the sterile field may be considered an area, immediately around a patient, who has been prepared for a surgical procedure. The sterile field may include the scrubbed team members, who are properly attired, and all furniture and fixtures in the area.
In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image-processing units, one or more storage arrays, and one or more displays that are strategically arranged with respect to the sterile field, as illustrated in
As illustrated in
In one aspect, the hub 106 is also configured to route a diagnostic input or feedback entered by a non-sterile operator at the visualization tower 111 to the primary display 119 within the sterile field, where it can be viewed by a sterile operator at the operating table. In one example, the input can be in the form of a modification to the snapshot displayed on the non-sterile display 107 or 109, which can be routed to the primary display 119 by the hub 106.
Referring to
Referring now to
During a surgical procedure, energy application to tissue, for sealing and/or cutting, is generally associated with smoke evacuation, suction of excess fluid, and/or irrigation of the tissue. Fluid, power, and/or data lines from different sources are often entangled during the surgical procedure. Valuable time can be lost addressing this issue during a surgical procedure. Detangling the lines may necessitate disconnecting the lines from their respective modules, which may require resetting the modules. The hub modular enclosure 136 offers a unified environment for managing the power, data, and fluid lines, which reduces the frequency of entanglement between such lines.
Aspects of the present disclosure present a surgical hub for use in a surgical procedure that involves energy application to tissue at a surgical site. The surgical hub includes a hub enclosure and a combo generator module slidably receivable in a docking station of the hub enclosure. The docking station includes data and power contacts. The combo generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component that are housed in a single unit. In one aspect, the combo generator module also includes a smoke evacuation component, at least one energy delivery cable for connecting the combo generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid, and/or particulates generated by the application of therapeutic energy to the tissue, and a fluid line extending from the remote surgical site to the smoke evacuation component.
In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module slidably received in the hub enclosure. In one aspect, the hub enclosure comprises a fluid interface.
Certain surgical procedures may require the application of more than one energy type to the tissue. One energy type may be more beneficial for cutting the tissue, while another different energy type may be more beneficial for sealing the tissue. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution where a hub modular enclosure 136 is configured to accommodate different generators, and facilitate an interactive communication therebetween. One of the advantages of the hub modular enclosure 136 is enabling the quick removal and/or replacement of various modules.
Aspects of the present disclosure present a modular surgical enclosure for use in a surgical procedure that involves energy application to tissue. The modular surgical enclosure includes a first energy-generator module, configured to generate a first energy for application to the tissue, and a first docking station comprising a first docking port that includes first data and power contacts, wherein the first energy-generator module is slidably movable into an electrical engagement with the power and data contacts and wherein the first energy-generator module is slidably movable out of the electrical engagement with the first power and data contacts.
Further to the above, the modular surgical enclosure also includes a second energy-generator module configured to generate a second energy, different than the first energy, for application to the tissue, and a second docking station comprising a second docking port that includes second data and power contacts, wherein the second energy-generator module is slidably movable into an electrical engagement with the power and data contacts, and wherein the second energy-generator module is slidably movable out of the electrical engagement with the second power and data contacts.
In addition, the modular surgical enclosure also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first energy-generator module and the second energy-generator module.
Referring to
In one aspect, the hub modular enclosure 136 comprises a modular power and communication backplane 149 with external and wireless communication headers to enable the removable attachment of the modules 140, 126, 128 and interactive communication therebetween.
In one aspect, the hub modular enclosure 136 includes docking stations, or drawers, 151, herein also referred to as drawers, which are configured to slidably receive the modules 140, 126, 128.
In various aspects, the smoke evacuation module 126 includes a fluid line 154 that conveys captured/collected smoke and/or fluid away from a surgical site and to, for example, the smoke evacuation module 126. Vacuum suction originating from the smoke evacuation module 126 can draw the smoke into an opening of a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, can be in the form of a flexible tube terminating at the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path extending toward the smoke evacuation module 126 that is received in the hub enclosure 136.
In various aspects, the suction/irrigation module 128 is coupled to a surgical tool comprising an aspiration fluid line and a suction fluid line. In one example, the aspiration and suction fluid lines are in the form of flexible tubes extending from the surgical site toward the suction/irrigation module 128. One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site.
In one aspect, the surgical tool includes a shaft having an end effector at a distal end thereof and at least one energy treatment associated with the end effector, an aspiration tube, and an irrigation tube. The aspiration tube can have an inlet port at a distal end thereof and the aspiration tube extends through the shaft. Similarly, an irrigation tube can extend through the shaft and can have an inlet port in proximity to the energy deliver implement. The energy deliver implement is configured to deliver ultrasonic and/or RF energy to the surgical site and is coupled to the generator module 140 by a cable extending initially through the shaft.
The irrigation tube can be in fluid communication with a fluid source, and the aspiration tube can be in fluid communication with a vacuum source. The fluid source and/or the vacuum source can be housed in the suction/irrigation module 128. In one example, the fluid source and/or the vacuum source can be housed in the hub enclosure 136 separately from the suction/irrigation module 128. In such example, a fluid interface can be configured to connect the suction/irrigation module 128 to the fluid source and/or the vacuum source.
In one aspect, the modules 140, 126, 128 and/or their corresponding docking stations on the hub modular enclosure 136 may include alignment features that are configured to align the docking ports of the modules into engagement with their counterparts in the docking stations of the hub modular enclosure 136. For example, as illustrated in
In some aspects, the drawers 151 of the hub modular enclosure 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers 151. For example, the side brackets 155 and/or 156 can be larger or smaller depending on the size of the module. In other aspects, the drawers 151 are different in size and are each designed to accommodate a particular module.
Furthermore, the contacts of a particular module can be keyed for engagement with the contacts of a particular drawer to avoid inserting a module into a drawer with mismatching contacts.
As illustrated in
In various aspects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular housing that can be assembled with a light source module and a camera module. The housing can be a disposable housing. In at least one example, the disposable housing is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and/or the camera module can be selectively chosen depending on the type of surgical procedure. In one aspect, the camera module comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for scanned beam imaging. Likewise, the light source module can be configured to deliver a white light or a different light, depending on the surgical procedure.
During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or a different light source can be inefficient. Temporarily losing sight of the surgical field may lead to undesirable consequences. The module imaging device of the present disclosure is configured to permit the replacement of a light source module or a camera module midstream during a surgical procedure, without having to remove the imaging device from the surgical field.
In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. A first channel is configured to slidably receive the camera module, which can be configured for a snap-fit engagement with the first channel. A second channel is configured to slidably receive the light source module, which can be configured for a snap-fit engagement with the second channel. In another example, the camera module and/or the light source module can be rotated into a final position within their respective channels. A threaded engagement can be employed in lieu of the snap-fit engagement.
In various examples, multiple imaging devices are placed at different positions in the surgical field to provide multiple views. The imaging module 138 can be configured to switch between the imaging devices to provide an optimal view. In various aspects, the imaging module 138 can be configured to integrate the images from the different imaging device.
Various image processors and imaging devices suitable for use with the present disclosure are described in U.S. Pat. No. 7,995,045, titled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, which issued on Aug. 9, 2011, which is herein incorporated by reference in its entirety. In addition, U.S. Pat. No. 7,982,776, titled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, which issued on Jul. 19, 2011, which is herein incorporated by reference in its entirety, describes various systems for removing motion artifacts from image data. Such systems can be integrated with the imaging module 138. Furthermore, U.S. Patent Application Publication No. 2011/0306840, titled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, which published on Dec. 15, 2011, and U.S. Patent Application Publication No. 2014/0243597, titled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, which published on Aug. 28, 2014, the disclosure of each of which is herein incorporated by reference in its entirety.
Modular devices 1a-1n located in the operating theater may be coupled to the modular communication hub 203. The network hub 207 and/or the network switch 209 may be coupled to a network router 211 to connect the devices 1a-1n to the cloud 204 or the local computer system 210. Data associated with the devices 1a-1n may be transferred to cloud-based computers via the router for remote data processing and manipulation. Data associated with the devices 1a-1n may also be transferred to the local computer system 210 for local data processing and manipulation. Modular devices 2a-2m located in the same operating theater also may be coupled to a network switch 209. The network switch 209 may be coupled to the network hub 207 and/or the network router 211 to connect to the devices 2a-2m to the cloud 204. Data associated with the devices 2a-2n may be transferred to the cloud 204 via the network router 211 for data processing and manipulation. Data associated with the devices 2a-2m may also be transferred to the local computer system 210 for local data processing and manipulation.
It will be appreciated that the surgical data network 201 may be expanded by interconnecting multiple network hubs 207 and/or multiple network switches 209 with multiple network routers 211. The modular communication hub 203 may be contained in a modular control tower configured to receive multiple devices 1a-1n/2a-2m. The local computer system 210 also may be contained in a modular control tower. The modular communication hub 203 is connected to a display 212 to display images obtained by some of the devices 1a-1n/2a-2m, for example during surgical procedures. In various aspects, the devices 1a-1n/2a-2m may include, for example, various modules such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, a suction/irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and/or a non-contact sensor module, among other modular devices that may be connected to the modular communication hub 203 of the surgical data network 201.
In one aspect, the surgical data network 201 may comprise a combination of network hub(s), network switch(es), and network router(s) connecting the devices 1a-1n/2a-2m to the cloud. Any one of or all of the devices 1a-1n/2a-2m coupled to the network hub or network switch may collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be appreciated that cloud computing relies on sharing computing resources rather than having local servers or personal devices to handle software applications. The word “cloud” may be used as a metaphor for “the Internet,” although the term is not limited as such. Accordingly, the term “cloud computing” may be used herein to refer to “a type of Internet-based computing,” where different services—such as servers, storage, and applications—are delivered to the modular communication hub 203 and/or computer system 210 located in the surgical theater (e.g., a fixed, mobile, temporary, or field operating room or space) and to devices connected to the modular communication hub 203 and/or computer system 210 through the Internet. The cloud infrastructure may be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the usage and control of the devices 1a-1n/2a-2m located in one or more operating theaters. The cloud computing services can perform a large number of calculations based on the data gathered by smart surgical instruments, robots, and other computerized devices located in the operating theater. The hub hardware enables multiple devices or connections to be connected to a computer that communicates with the cloud computing resources and storage.
Applying cloud computer data processing techniques on the data collected by the devices 1a-1n/2a-2m, the surgical data network provides improved surgical outcomes, reduced costs, and improved patient satisfaction. At least some of the devices 1a-1n/2a-2m may be employed to view tissue states to assess leaks or perfusion of sealed tissue after a tissue sealing and cutting procedure. At least some of the devices 1a-1n/2a-2m may be employed to identify pathology, such as the effects of diseases, using the cloud-based computing to examine data including images of samples of body tissue for diagnostic purposes. This includes localization and margin confirmation of tissue and phenotypes. At least some of the devices 1a-1n/2a-2m may be employed to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. The data gathered by the devices 1a-1n/2a-2m, including image data, may be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including image processing and manipulation. The data may be analyzed to improve surgical procedure outcomes by determining if further treatment, such as the application of endoscopic intervention, emerging technologies, a targeted radiation, targeted intervention, and precise robotics to tissue-specific sites and conditions, may be pursued. Such data analysis may further employ outcome analytics processing, and using standardized approaches may provide beneficial feedback to either confirm surgical treatments and the behavior of the surgeon or suggest modifications to surgical treatments and the behavior of the surgeon.
In one implementation, the operating theater devices 1a-1n may be connected to the modular communication hub 203 over a wired channel or a wireless channel depending on the configuration of the devices 1a-1n to a network hub. The network hub 207 may be implemented, in one aspect, as a local network broadcast device that works on the physical layer of the Open System Interconnection (OSI) model. The network hub provides connectivity to the devices 1a-1n located in the same operating theater network. The network hub 207 collects data in the form of packets and sends them to the router in half duplex mode. The network hub 207 does not store any media access control/Internet Protocol (MAC/IP) to transfer the device data. Only one of the devices 1a-1n can send data at a time through the network hub 207. The network hub 207 has no routing tables or intelligence regarding where to send information and broadcasts all network data across each connection and to a remote server 213 (
In another implementation, the operating theater devices 2a-2m may be connected to a network switch 209 over a wired channel or a wireless channel. The network switch 209 works in the data link layer of the OSI model. The network switch 209 is a multicast device for connecting the devices 2a-2m located in the same operating theater to the network. The network switch 209 sends data in the form of frames to the network router 211 and works in full duplex mode. Multiple devices 2a-2m can send data at the same time through the network switch 209. The network switch 209 stores and uses MAC addresses of the devices 2a-2m to transfer data.
The network hub 207 and/or the network switch 209 are coupled to the network router 211 for connection to the cloud 204. The network router 211 works in the network layer of the OSI model. The network router 211 creates a route for transmitting data packets received from the network hub 207 and/or network switch 211 to cloud-based computer resources for further processing and manipulation of the data collected by any one of or all the devices 1a-1n/2a-2m. The network router 211 may be employed to connect two or more different networks located in different locations, such as, for example, different operating theaters of the same healthcare facility or different networks located in different operating theaters of different healthcare facilities. The network router 211 sends data in the form of packets to the cloud 204 and works in full duplex mode. Multiple devices can send data at the same time. The network router 211 uses IP addresses to transfer data.
In one example, the network hub 207 may be implemented as a USB hub, which allows multiple USB devices to be connected to a host computer. The USB hub may expand a single USB port into several tiers so that there are more ports available to connect devices to the host system computer. The network hub 207 may include wired or wireless capabilities to receive information over a wired channel or a wireless channel. In one aspect, a wireless USB short-range, high-bandwidth wireless radio communication protocol may be employed for communication between the devices 1a-1n and devices 2a-2m located in the operating theater.
In other examples, the operating theater devices 1a-1n/2a-2m may communicate to the modular communication hub 203 via Bluetooth wireless technology standard for exchanging data over short distances (using short-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz) from fixed and mobile devices and building personal area networks (PANs). In other aspects, the operating theater devices 1a-1n/2a-2m may communicate to the modular communication hub 203 via a number of wireless or wired communication standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 family), WMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module may include a plurality of communication modules. For instance, a first communication module may be dedicated to shorter-range wireless communications such as Wi-Fi and Bluetooth, and a second communication module may be dedicated to longer-range wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, and others.
The modular communication hub 203 may serve as a central connection for one or all of the operating theater devices 1a-1n/2a-2m and handles a data type known as frames. Frames carry the data generated by the devices 1a-1n/2a-2m. When a frame is received by the modular communication hub 203, it is amplified and transmitted to the network router 211, which transfers the data to the cloud computing resources by using a number of wireless or wired communication standards or protocols, as described herein.
The modular communication hub 203 can be used as a standalone device or be connected to compatible network hubs and network switches to form a larger network. The modular communication hub 203 is generally easy to install, configure, and maintain, making it a good option for networking the operating theater devices 1a-1n/2a-2m.
The surgical hub 206 employs a non-contact sensor module 242 to measure the dimensions of the operating theater and generate a map of the surgical theater using either ultrasonic or laser-type non-contact measurement devices. An ultrasound-based non-contact sensor module scans the operating theater by transmitting a burst of ultrasound and receiving the echo when it bounces off the perimeter walls of an operating theater as described under the heading “Surgical Hub Spatial Awareness Within an Operating Room” in U.S. Provisional Patent Application Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, which is herein incorporated by reference in its entirety, in which the sensor module is configured to determine the size of the operating theater and to adjust Bluetooth-pairing distance limits. A laser-based non-contact sensor module scans the operating theater by transmitting laser light pulses, receiving laser light pulses that bounce off the perimeter walls of the operating theater, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating theater and to adjust Bluetooth pairing distance limits, for example.
The computer system 210 comprises a processor 244 and a network interface 245. The processor 244 is coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250, and input/output interface 251 via a system bus. The system bus can be any of several types of bus structure(s) including the memory bus or memory controller, a peripheral bus or external bus, and/or a local bus using any variety of available bus architectures including, but not limited to, 9-bit bus, Industrial Standard Architecture (ISA), Micro-Channel Architecture (MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESA Local Bus (VLB), Peripheral Component Interconnect (PCI), USB, Advanced Graphics Port (AGP), Personal Computer Memory Card International Association bus (PCMCIA), Small Computer Systems Interface (SCSI), or any other proprietary bus.
The processor 244 may be any single-core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the processor may be an LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising an on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with StellarisWare® software, a 2 KB electrically erasable programmable read-only memory (EEPROM), and/or one or more pulse width modulation (PWM) modules, one or more quadrature encoder inputs (QEI) analogs, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, details of which are available for the product datasheet.
In one aspect, the processor 244 may comprise a safety controller comprising two controller-based families such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options.
The system memory includes volatile memory and non-volatile memory. The basic input/output system (BIOS), containing the basic routines to transfer information between elements within the computer system, such as during start-up, is stored in non-volatile memory. For example, the non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random-access memory (RAM), which acts as external cache memory. Moreover, RAM is available in many forms such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct Rambus RAM (DRRAM).
The computer system 210 also includes removable/non-removable, volatile/non-volatile computer storage media, such as for example disk storage. The disk storage includes, but is not limited to, devices like a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card, or memory stick. In addition, the disk storage can include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM device (CD-ROM), compact disc recordable drive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or a digital versatile disc ROM drive (DVD-ROM). To facilitate the connection of the disk storage devices to the system bus, a removable or non-removable interface may be employed.
It is to be appreciated that the computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on the disk storage, acts to control and allocate resources of the computer system. System applications take advantage of the management of resources by the operating system through program modules and program data stored either in the system memory or on the disk storage. It is to be appreciated that various components described herein can be implemented with various operating systems or combinations of operating systems.
A user enters commands or information into the computer system 210 through input device(s) coupled to the I/O interface 251. The input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, touch pad, keyboard, microphone, joystick, game pad, satellite dish, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor through the system bus via interface port(s). The interface port(s) include, for example, a serial port, a parallel port, a game port, and a USB. The output device(s) use some of the same types of ports as input device(s). Thus, for example, a USB port may be used to provide input to the computer system and to output information from the computer system to an output device. An output adapter is provided to illustrate that there are some output devices like monitors, displays, speakers, and printers, among other output devices that require special adapters. The output adapters include, by way of illustration and not limitation, video and sound cards that provide a means of connection between the output device and the system bus. It should be noted that other devices and/or systems of devices, such as remote computer(s), provide both input and output capabilities.
The computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computer(s), or local computers. The remote cloud computer(s) can be a personal computer, server, router, network PC, workstation, microprocessor-based appliance, peer device, or other common network node, and the like, and typically includes many or all of the elements described relative to the computer system. For purposes of brevity, only a memory storage device is illustrated with the remote computer(s). The remote computer(s) is logically connected to the computer system through a network interface and then physically connected via a communication connection. The network interface encompasses communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE 802.5 and the like. WAN technologies include, but are not limited to, point-to-point links, circuit-switching networks like Integrated Services Digital Networks (ISDN) and variations thereon, packet-switching networks, and Digital Subscriber Lines (DSL).
In various aspects, the computer system 210 of
The communication connection(s) refers to the hardware/software employed to connect the network interface to the bus. While the communication connection is shown for illustrative clarity inside the computer system, it can also be external to the computer system 210. The hardware/software necessary for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone-grade modems, cable modems, and DSL modems, ISDN adapters, and Ethernet cards.
The USB network hub 300 device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compliant USB transceivers are integrated into the circuit for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full-speed and low-speed devices by automatically setting the slew rate according to the speed of the device attached to the ports. The USB network hub 300 device may be configured either in bus-powered or self-powered mode and includes a hub power logic 312 to manage power.
The USB network hub 300 device includes a serial interface engine 310 (SIE). The SIE 310 is the front end of the USB network hub 300 hardware and handles most of the protocol described in chapter 8 of the USB specification. The SIE 310 typically comprehends signaling up to the transaction level. The functions that it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection/generation, clock/data separation, non-return-to-zero invert (NRZI) data encoding/decoding and bit-stuffing, CRC generation and checking (token and data), packet ID (PID) generation and checking/decoding, and/or serial-parallel/parallel-serial conversion. The 310 receives a clock input 314 and is coupled to a suspend/resume logic and frame timer 316 circuit and a hub repeater circuit 318 to control communication between the upstream USB transceiver port 302 and the downstream USB transceiver ports 304, 306, 308 through port logic circuits 320, 322, 324. The SIE 310 is coupled to a command decoder 326 via interface logic to control commands from a serial EEPROM via a serial EEPROM interface 330.
In various aspects, the USB network hub 300 can connect 127 functions configured in up to six logical layers (tiers) to a single computer. Further, the USB network hub 300 can connect to all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power configurations are bus-powered and self-powered modes. The USB network hub 300 may be configured to support four modes of power management: a bus-powered hub, with either individual-port power management or ganged-port power management, and the self-powered hub, with either individual-port power management or ganged-port power management. In one aspect, using a USB cable, the USB network hub 300, the upstream USB transceiver port 302 is plugged into a USB host controller, and the downstream USB transceiver ports 304, 306, 308 are exposed for connecting USB compatible devices, and so forth.
Surgical Instrument Hardware
In one aspect, the microcontroller 461 may be any single-core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the main microcontroller 461 may be an LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising an on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle SRAM, and internal ROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, and/or one or more 12-bit ADCs with 12 analog input channels, details of which are available for the product datasheet.
In one aspect, the microcontroller 461 may comprise a safety controller comprising two controller-based families such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options.
The microcontroller 461 may be programmed to perform various functions such as precise control over the speed and position of the knife and articulation systems. In one aspect, the microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 may be a brushed direct current (DC) motor with a gearbox and mechanical links to an articulation or knife system. In one aspect, a motor driver 492 may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers may be readily substituted for use in the tracking system 480 comprising an absolute positioning system. A detailed description of an absolute positioning system is described in U.S. Patent Application Publication No. 2017/0296213, titled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, which published on Oct. 19, 2017, which is herein incorporated by reference in its entirety.
The microcontroller 461 may be programmed to provide precise control over the speed and position of displacement members and articulation systems. The microcontroller 461 may be configured to compute a response in the software of the microcontroller 461. The computed response is compared to a measured response of the actual system to obtain an “observed” response, which is used for actual feedback decisions. The observed response is a favorable, tuned value that balances the smooth, continuous nature of the simulated response with the measured response, which can detect outside influences on the system.
In one aspect, the motor 482 may be controlled by the motor driver 492 and can be employed by the firing system of the surgical instrument or tool. In various forms, the motor 482 may be a brushed DC driving motor having a maximum rotational speed of approximately 25,000 RPM. In other arrangements, the motor 482 may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor driver 492 may comprise an H-bridge driver comprising field-effect transistors (FETs), for example. The motor 482 can be powered by a power assembly releasably mounted to the handle assembly or tool housing for supplying control power to the surgical instrument or tool. The power assembly may comprise a battery which may include a number of battery cells connected in series that can be used as the power source to power the surgical instrument or tool. In certain circumstances, the battery cells of the power assembly may be replaceable and/or rechargeable. In at least one example, the battery cells can be lithium-ion batteries which can be couplable to and separable from the power assembly.
The motor driver 492 may be an A3941 available from Allegro Microsystems, Inc. The A3941 492 is a full-bridge controller for use with external N-channel power metal-oxide semiconductor field-effect transistors (MOSFETs) specifically designed for inductive loads, such as brush DC motors. The driver 492 comprises a unique charge pump regulator that provides full (>10 V) gate drive for battery voltages down to 7 V and allows the A3941 to operate with a reduced gate drive, down to 5.5 V. A bootstrap capacitor may be employed to provide the above battery supply voltage required for N-channel MOSFETs. An internal charge pump for the high-side drive allows DC (100% duty cycle) operation. The full bridge can be driven in fast or slow decay modes using diode or synchronous rectification. In the slow decay mode, current recirculation can be through the high-side or the lowside FETs. The power FETs are protected from shoot-through by resistor-adjustable dead time. Integrated diagnostics provide indications of undervoltage, overtemperature, and power bridge faults and can be configured to protect the power MOSFETs under most short circuit conditions. Other motor drivers may be readily substituted for use in the tracking system 480 comprising an absolute positioning system.
The tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472, in accordance with at least one aspect of this disclosure. The position sensor 472 for an absolute positioning system provides a unique position signal corresponding to the location of a displacement member. In one aspect, the displacement member represents a longitudinally movable drive member comprising a rack of drive teeth for meshing engagement with a corresponding drive gear of a gear reducer assembly. In other aspects, the displacement member represents the firing member, which could be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a firing bar or the I-beam, each of which can be adapted and configured to include a rack of drive teeth. Accordingly, as used herein, the term displacement member is used generically to refer to any movable member of the surgical instrument or tool such as the drive member, the firing member, the firing bar, the I-beam, or any element that can be displaced. In one aspect, the longitudinally movable drive member is coupled to the firing member, the firing bar, and the I-beam. Accordingly, the absolute positioning system can, in effect, track the linear displacement of the I-beam by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any position sensor 472 suitable for measuring linear displacement. Thus, the longitudinally movable drive member, the firing member, the firing bar, or the I-beam, or combinations thereof, may be coupled to any suitable linear displacement sensor. Linear displacement sensors may include contact or non-contact displacement sensors. Linear displacement sensors may comprise linear variable differential transformers (LVDT), differential variable reluctance transducers (DVRT), a slide potentiometer, a magnetic sensing system comprising a movable magnet and a series of linearly arranged Hall effect sensors, a magnetic sensing system comprising a fixed magnet and a series of movable, linearly arranged Hall effect sensors, an optical sensing system comprising a movable light source and a series of linearly arranged photo diodes or photo detectors, an optical sensing system comprising a fixed light source and a series of movable linearly, arranged photo diodes or photo detectors, or any combination thereof.
The electric motor 482 can include a rotatable shaft that operably interfaces with a gear assembly that is mounted in meshing engagement with a set, or rack, of drive teeth on the displacement member. A sensor element may be operably coupled to a gear assembly such that a single revolution of the position sensor 472 element corresponds to some linear longitudinal translation of the displacement member. An arrangement of gearing and sensors can be connected to the linear actuator, via a rack and pinion arrangement, or a rotary actuator, via a spur gear or other connection. A power source supplies power to the absolute positioning system and an output indicator may display the output of the absolute positioning system. The displacement member represents the longitudinally movable drive member comprising a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, firing bar, I-beam, or combinations thereof.
A single revolution of the sensor element associated with the position sensor 472 is equivalent to a longitudinal linear displacement d1 of the of the displacement member, where d1 is the longitudinal linear distance that the displacement member moves from point “a” to point “b” after a single revolution of the sensor element coupled to the displacement member. The sensor arrangement may be connected via a gear reduction that results in the position sensor 472 completing one or more revolutions for the full stroke of the displacement member. The position sensor 472 may complete multiple revolutions for the full stroke of the displacement member.
A series of switches, where n is an integer greater than one, may be employed alone or in combination with a gear reduction to provide a unique position signal for more than one revolution of the position sensor 472. The state of the switches are fed back to the microcontroller 461 that applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d1+d2+ . . . dn of the displacement member. The output of the position sensor 472 is provided to the microcontroller 461. The position sensor 472 of the sensor arrangement may comprise a magnetic sensor, an analog rotary sensor like a potentiometer, or an array of analog Hall-effect elements, which output a unique combination of position signals or values.
The position sensor 472 may comprise any number of magnetic sensing elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors encompass many aspects of physics and electronics. The technologies used for magnetic field sensing include search coil, fluxgate, optically pumped, nuclear precession, SQUID, Hall-effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive/piezoelectric composites, magnetodiode, magnetotransistor, fiber-optic, magneto-optic, and microelectromechanical systems-based magnetic sensors, among others.
In one aspect, the position sensor 472 for the tracking system 480 comprising an absolute positioning system comprises a magnetic rotary absolute positioning system. The position sensor 472 may be implemented as an AS5055EQFT single-chip magnetic rotary position sensor available from Austria Microsystems, AG. The position sensor 472 is interfaced with the microcontroller 461 to provide an absolute positioning system. The position sensor 472 is a low-voltage and low-power component and includes four Hall-effect elements in an area of the position sensor 472 that is located above a magnet. A high-resolution ADC and a smart power management controller are also provided on the chip. A coordinate rotation digital computer (CORDIC) processor, also known as the digit-by-digit method and Volder's algorithm, is provided to implement a simple and efficient algorithm to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bitshift, and table lookup operations. The angle position, alarm bits, and magnetic field information are transmitted over a standard serial communication interface, such as a serial peripheral interface (SPI) interface, to the microcontroller 461. The position sensor 472 provides 12 or 14 bits of resolution. The position sensor 472 may be an AS5055 chip provided in a small QFN 16-pin 4×4×0.85 mm package.
The tracking system 480 comprising an absolute positioning system may comprise and/or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power source converts the signal from the feedback controller into a physical input to the system: in this case the voltage. Other examples include a PWM of the voltage, current, and force. Other sensor(s) may be provided to measure physical parameters of the physical system in addition to the position measured by the position sensor 472. In some aspects, the other sensor(s) can include sensor arrangements such as those described in U.S. Pat. No. 9,345,481, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which issued on May 24, 2016, which is herein incorporated by reference in its entirety; U.S. Patent Application Publication No. 2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which published on Sep. 18, 2014, which is herein incorporated by reference in its entirety; and U.S. patent application Ser. No. 15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is herein incorporated by reference in its entirety. In a digital signal processing system, an absolute positioning system is coupled to a digital data acquisition system where the output of the absolute positioning system will have a finite resolution and sampling frequency. The absolute positioning system may comprise a compare-and-combine circuit to combine a computed response with a measured response using algorithms, such as a weighted average and a theoretical control loop, that drive the computed response towards the measured response. The computed response of the physical system takes into account properties like mass, inertial, viscous friction, inductance resistance, etc., to predict what the states and outputs of the physical system will be by knowing the input.
The absolute positioning system provides an absolute position of the displacement member upon power-up of the instrument, without retracting or advancing the displacement member to a reset (zero or home) position as may be required with conventional rotary encoders that merely count the number of steps forwards or backwards that the motor 482 has taken to infer the position of a device actuator, drive bar, knife, or the like.
A sensor 474, such as, for example, a strain gauge or a micro-strain gauge, is configured to measure one or more parameters of the end effector, such as, for example, the amplitude of the strain exerted on the anvil during a clamping operation, which can be indicative of the closure forces applied to the anvil. The measured strain is converted to a digital signal and provided to the processor 462. Alternatively, or in addition to the sensor 474, a sensor 476, such as, for example, a load sensor, can measure the closure force applied by the closure drive system to the anvil. The sensor 476, such as, for example, a load sensor, can measure the firing force applied to an I-beam in a firing stroke of the surgical instrument or tool. The I-beam is configured to engage a wedge sled, which is configured to upwardly cam staple drivers to force out staples into deforming contact with an anvil. The I-beam also includes a sharpened cutting edge that can be used to sever tissue as the I-beam is advanced distally by the firing bar. Alternatively, a current sensor 478 can be employed to measure the current drawn by the motor 482. The force required to advance the firing member can correspond to the current drawn by the motor 482, for example. The measured force is converted to a digital signal and provided to the processor 462.
In one form, the strain gauge sensor 474 can be used to measure the force applied to the tissue by the end effector. A strain gauge can be coupled to the end effector to measure the force on the tissue being treated by the end effector. A system for measuring forces applied to the tissue grasped by the end effector comprises a strain gauge sensor 474, such as, for example, a micro-strain gauge, that is configured to measure one or more parameters of the end effector, for example. In one aspect, the strain gauge sensor 474 can measure the amplitude or magnitude of the strain exerted on a jaw member of an end effector during a clamping operation, which can be indicative of the tissue compression. The measured strain is converted to a digital signal and provided to a processor 462 of the microcontroller 461. A load sensor 476 can measure the force used to operate the knife element, for example, to cut the tissue captured between the anvil and the staple cartridge. A magnetic field sensor can be employed to measure the thickness of the captured tissue. The measurement of the magnetic field sensor also may be converted to a digital signal and provided to the processor 462.
The measurements of the tissue compression, the tissue thickness, and/or the force required to close the end effector on the tissue, as respectively measured by the sensors 474, 476, can be used by the microcontroller 461 to characterize the selected position of the firing member and/or the corresponding value of the speed of the firing member. In one instance, a memory 468 may store a technique, an equation, and/or a lookup table which can be employed by the microcontroller 461 in the assessment.
The control system 470 of the surgical instrument or tool also may comprise wired or wireless communication circuits to communicate with the modular communication hub as shown in
In certain instances, the surgical instrument system or tool may include a firing motor 602. The firing motor 602 may be operably coupled to a firing motor drive assembly 604 which can be configured to transmit firing motions, generated by the motor 602 to the end effector, in particular to displace the I-beam element. In certain instances, the firing motions generated by the motor 602 may cause the staples to be deployed from the staple cartridge into tissue captured by the end effector and/or the cutting edge of the I-beam element to be advanced to cut the captured tissue, for example. The I-beam element may be retracted by reversing the direction of the motor 602.
In certain instances, the surgical instrument or tool may include a closure motor 603. The closure motor 603 may be operably coupled to a closure motor drive assembly 605 which can be configured to transmit closure motions, generated by the motor 603 to the end effector, in particular to displace a closure tube to close the anvil and compress tissue between the anvil and the staple cartridge. The closure motions may cause the end effector to transition from an open configuration to an approximated configuration to capture tissue, for example. The end effector may be transitioned to an open position by reversing the direction of the motor 603.
In certain instances, the surgical instrument or tool may include one or more articulation motors 606a, 606b, for example. The motors 606a, 606b may be operably coupled to respective articulation motor drive assemblies 608a, 608b, which can be configured to transmit articulation motions generated by the motors 606a, 606b to the end effector. In certain instances, the articulation motions may cause the end effector to articulate relative to the shaft, for example.
As described above, the surgical instrument or tool may include a plurality of motors which may be configured to perform various independent functions. In certain instances, the plurality of motors of the surgical instrument or tool can be individually or separately activated to perform one or more functions while the other motors remain inactive. For example, the articulation motors 606a, 606b can be activated to cause the end effector to be articulated while the firing motor 602 remains inactive. Alternatively, the firing motor 602 can be activated to fire the plurality of staples, and/or to advance the cutting edge, while the articulation motor 606 remains inactive. Furthermore, the closure motor 603 may be activated simultaneously with the firing motor 602 to cause the closure tube and the I-beam element to advance distally as described in more detail hereinbelow.
In certain instances, the surgical instrument or tool may include a common control module 610 which can be employed with a plurality of motors of the surgical instrument or tool. In certain instances, the common control module 610 may accommodate one of the plurality of motors at a time. For example, the common control module 610 can be couplable to and separable from the plurality of motors of the robotic surgical instrument individually. In certain instances, a plurality of the motors of the surgical instrument or tool may share one or more common control modules such as the common control module 610. In certain instances, a plurality of motors of the surgical instrument or tool can be individually and selectively engaged with the common control module 610. In certain instances, the common control module 610 can be selectively switched from interfacing with one of a plurality of motors of the surgical instrument or tool to interfacing with another one of the plurality of motors of the surgical instrument or tool.
In at least one example, the common control module 610 can be selectively switched between operable engagement with the articulation motors 606a, 606b and operable engagement with either the firing motor 602 or the closure motor 603. In at least one example, as illustrated in
Each of the motors 602, 603, 606a, 606b may comprise a torque sensor to measure the output torque on the shaft of the motor. The force on an end effector may be sensed in any conventional manner, such as by force sensors on the outer sides of the jaws or by a torque sensor for the motor actuating the jaws.
In various instances, as illustrated in
In certain instances, the microcontroller 620 may include a microprocessor 622 (the “processor”) and one or more non-transitory computer-readable mediums or memory units 624 (the “memory”). In certain instances, the memory 624 may store various program instructions, which when executed may cause the processor 622 to perform a plurality of functions and/or calculations described herein. In certain instances, one or more of the memory units 624 may be coupled to the processor 622, for example.
In certain instances, the power source 628 can be employed to supply power to the microcontroller 620, for example. In certain instances, the power source 628 may comprise a battery (or “battery pack” or “power pack”), such as a lithium-ion battery, for example. In certain instances, the battery pack may be configured to be releasably mounted to a handle for supplying power to the surgical instrument 600. A number of battery cells connected in series may be used as the power source 628. In certain instances, the power source 628 may be replaceable and/or rechargeable, for example.
In various instances, the processor 622 may control the motor driver 626 to control the position, direction of rotation, and/or velocity of a motor that is coupled to the common control module 610. In certain instances, the processor 622 can signal the motor driver 626 to stop and/or disable a motor that is coupled to the common control module 610. It should be understood that the term “processor” as used herein includes any suitable microprocessor, microcontroller, or other basic computing device that incorporates the functions of a computer's central processing unit (CPU) on an integrated circuit or, at most, a few integrated circuits. The processor is a multipurpose, programmable device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. It is an example of sequential digital logic, as it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system.
In one instance, the processor 622 may be any single-core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F Processor Core comprising an on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle SRAM, an internal ROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, one or more 12-bit ADCs with 12 analog input channels, among other features that are readily available for the product datasheet. Other microcontrollers may be readily substituted for use with the module 4410. Accordingly, the present disclosure should not be limited in this context.
In certain instances, the memory 624 may include program instructions for controlling each of the motors of the surgical instrument 600 that are couplable to the common control module 610. For example, the memory 624 may include program instructions for controlling the firing motor 602, the closure motor 603, and the articulation motors 606a, 606b. Such program instructions may cause the processor 622 to control the firing, closure, and articulation functions in accordance with inputs from algorithms or control programs of the surgical instrument or tool.
In certain instances, one or more mechanisms and/or sensors such as, for example, sensors 630 can be employed to alert the processor 622 to the program instructions that should be used in a particular setting. For example, the sensors 630 may alert the processor 622 to use the program instructions associated with firing, closing, and articulating the end effector. In certain instances, the sensors 630 may comprise position sensors which can be employed to sense the position of the switch 614, for example. Accordingly, the processor 622 may use the program instructions associated with firing the I-beam of the end effector upon detecting, through the sensors 630 for example, that the switch 614 is in the first position 616; the processor 622 may use the program instructions associated with closing the anvil upon detecting, through the sensors 630 for example, that the switch 614 is in the second position 617; and the processor 622 may use the program instructions associated with articulating the end effector upon detecting, through the sensors 630 for example, that the switch 614 is in the third or fourth position 618a, 618b.
In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and an I-beam 714 (including a sharp cutting edge) portion of an end effector 702, a removable staple cartridge 718, a shaft 740, and one or more articulation members 742a, 742b via a plurality of motors 704a-704e. A position sensor 734 may be configured to provide position feedback of the I-beam 714 to the control circuit 710. Other sensors 738 may be configured to provide feedback to the control circuit 710. A timer/counter 731 provides timing and counting information to the control circuit 710. An energy source 712 may be provided to operate the motors 704a-704e, and a current sensor 736 provides motor current feedback to the control circuit 710. The motors 704a-704e can be operated individually by the control circuit 710 in an open-loop or closed-loop feedback control.
In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer/counter 731 provides an output signal, such as the elapsed time or a digital count, to the control circuit 710 to correlate the position of the I-beam 714 as determined by the position sensor 734 with the output of the timer/counter 731 such that the control circuit 710 can determine the position of the I-beam 714 at a specific time (t) relative to a starting position or the time (t) when the I-beam 714 is at a specific position relative to a starting position. The timer/counter 731 may be configured to measure elapsed time, count external events, or time external events.
In one aspect, the control circuit 710 may be programmed to control functions of the end effector 702 based on one or more tissue conditions. The control circuit 710 may be programmed to sense tissue conditions, such as thickness, either directly or indirectly, as described herein. The control circuit 710 may be programmed to select a firing control program or closure control program based on tissue conditions. A firing control program may describe the distal motion of the displacement member. Different firing control programs may be selected to better treat different tissue conditions. For example, when thicker tissue is present, the control circuit 710 may be programmed to translate the displacement member at a lower velocity and/or with lower power. When thinner tissue is present, the control circuit 710 may be programmed to translate the displacement member at a higher velocity and/or with higher power. A closure control program may control the closure force applied to the tissue by the anvil 716. Other control programs control the rotation of the shaft 740 and the articulation members 742a, 742b.
In one aspect, the control circuit 710 may generate motor set point signals. The motor set point signals may be provided to various motor controllers 708a-708e. The motor controllers 708a-708e may comprise one or more circuits configured to provide motor drive signals to the motors 704a-704e to drive the motors 704a-704e as described herein. In some examples, the motors 704a-704e may be brushed DC electric motors. For example, the velocity of the motors 704a-704e may be proportional to the respective motor drive signals. In some examples, the motors 704a-704e may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal provided to one or more stator windings of the motors 704a-704e. Also, in some examples, the motor controllers 708a-708e may be omitted and the control circuit 710 may generate the motor drive signals directly.
In one aspect, the control circuit 710 may initially operate each of the motors 704a-704e in an open-loop configuration for a first open-loop portion of a stroke of the displacement member. Based on the response of the robotic surgical instrument 700 during the open-loop portion of the stroke, the control circuit 710 may select a firing control program in a closed-loop configuration. The response of the instrument may include a translation distance of the displacement member during the open-loop portion, a time elapsed during the open-loop portion, the energy provided to one of the motors 704a-704e during the open-loop portion, a sum of pulse widths of a motor drive signal, etc. After the open-loop portion, the control circuit 710 may implement the selected firing control program for a second portion of the displacement member stroke. For example, during a closed-loop portion of the stroke, the control circuit 710 may modulate one of the motors 704a-704e based on translation data describing a position of the displacement member in a closed-loop manner to translate the displacement member at a constant velocity.
In one aspect, the motors 704a-704e may receive power from an energy source 712. The energy source 712 may be a DC power supply driven by a main alternating current power source, a battery, a super capacitor, or any other suitable energy source. The motors 704a-704e may be mechanically coupled to individual movable mechanical elements such as the I-beam 714, anvil 716, shaft 740, articulation 742a, and articulation 742b via respective transmissions 706a-706e. The transmissions 706a-706e may include one or more gears or other linkage components to couple the motors 704a-704e to movable mechanical elements. A position sensor 734 may sense a position of the I-beam 714. The position sensor 734 may be or include any type of sensor that is capable of generating position data that indicate a position of the I-beam 714. In some examples, the position sensor 734 may include an encoder configured to provide a series of pulses to the control circuit 710 as the I-beam 714 translates distally and proximally. The control circuit 710 may track the pulses to determine the position of the I-beam 714. Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals indicating motion of the I-beam 714. Also, in some examples, the position sensor 734 may be omitted. Where any of the motors 704a-704e is a stepper motor, the control circuit 710 may track the position of the I-beam 714 by aggregating the number and direction of steps that the motor 704 has been instructed to execute. The position sensor 734 may be located in the end effector 702 or at any other portion of the instrument. The outputs of each of the motors 704a-704e include a torque sensor 744a-744e to sense force and have an encoder to sense rotation of the drive shaft.
In one aspect, the control circuit 710 is configured to drive a firing member such as the I-beam 714 portion of the end effector 702. The control circuit 710 provides a motor set point to a motor control 708a, which provides a drive signal to the motor 704a. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the I-beam 714. The transmission 706a comprises movable mechanical elements such as rotating elements and a firing member to control the movement of the I-beam 714 distally and proximally along a longitudinal axis of the end effector 702. In one aspect, the motor 704a may be coupled to the knife gear assembly, which includes a knife gear reduction set that includes a first knife drive gear and a second knife drive gear. A torque sensor 744a provides a firing force feedback signal to the control circuit 710. The firing force signal represents the force required to fire or displace the I-beam 714. A position sensor 734 may be configured to provide the position of the I-beam 714 along the firing stroke or the position of the firing member as a feedback signal to the control circuit 710. The end effector 702 may include additional sensors 738 configured to provide feedback signals to the control circuit 710. When ready to use, the control circuit 710 may provide a firing signal to the motor control 708a. In response to the firing signal, the motor 704a may drive the firing member distally along the longitudinal axis of the end effector 702 from a proximal stroke start position to a stroke end position distal to the stroke start position. As the firing member translates distally, an I-beam 714, with a cutting element positioned at a distal end, advances distally to cut tissue located between the staple cartridge 718 and the anvil 716.
In one aspect, the control circuit 710 is configured to drive a closure member such as the anvil 716 portion of the end effector 702. The control circuit 710 provides a motor set point to a motor control 708b, which provides a drive signal to the motor 704b. The output shaft of the motor 704b is coupled to a torque sensor 744b. The torque sensor 744b is coupled to a transmission 706b which is coupled to the anvil 716. The transmission 706b comprises movable mechanical elements such as rotating elements and a closure member to control the movement of the anvil 716 from the open and closed positions. In one aspect, the motor 704b is coupled to a closure gear assembly, which includes a closure reduction gear set that is supported in meshing engagement with the closure spur gear. The torque sensor 744b provides a closure force feedback signal to the control circuit 710. The closure force feedback signal represents the closure force applied to the anvil 716. The position sensor 734 may be configured to provide the position of the closure member as a feedback signal to the control circuit 710. Additional sensors 738 in the end effector 702 may provide the closure force feedback signal to the control circuit 710. The pivotable anvil 716 is positioned opposite the staple cartridge 718. When ready to use, the control circuit 710 may provide a closure signal to the motor control 708b. In response to the closure signal, the motor 704b advances a closure member to grasp tissue between the anvil 716 and the staple cartridge 718.
In one aspect, the control circuit 710 is configured to rotate a shaft member such as the shaft 740 to rotate the end effector 702. The control circuit 710 provides a motor set point to a motor control 708c, which provides a drive signal to the motor 704c. The output shaft of the motor 704c is coupled to a torque sensor 744c. The torque sensor 744c is coupled to a transmission 706c which is coupled to the shaft 740. The transmission 706c comprises movable mechanical elements such as rotating elements to control the rotation of the shaft 740 clockwise or counterclockwise up to and over 360°. In one aspect, the motor 704c is coupled to the rotational transmission assembly, which includes a tube gear segment that is formed on (or attached to) the proximal end of the proximal closure tube for operable engagement by a rotational gear assembly that is operably supported on the tool mounting plate. The torque sensor 744c provides a rotation force feedback signal to the control circuit 710. The rotation force feedback signal represents the rotation force applied to the shaft 740. The position sensor 734 may be configured to provide the position of the closure member as a feedback signal to the control circuit 710. Additional sensors 738 such as a shaft encoder may provide the rotational position of the shaft 740 to the control circuit 710.
In one aspect, the control circuit 710 is configured to articulate the end effector 702. The control circuit 710 provides a motor set point to a motor control 708d, which provides a drive signal to the motor 704d. The output shaft of the motor 704d is coupled to a torque sensor 744d. The torque sensor 744d is coupled to a transmission 706d which is coupled to an articulation member 742a. The transmission 706d comprises movable mechanical elements such as articulation elements to control the articulation of the end effector 702 ±65°. In one aspect, the motor 704d is coupled to an articulation nut, which is rotatably journaled on the proximal end portion of the distal spine portion and is rotatably driven thereon by an articulation gear assembly. The torque sensor 744d provides an articulation force feedback signal to the control circuit 710. The articulation force feedback signal represents the articulation force applied to the end effector 702. Sensors 738, such as an articulation encoder, may provide the articulation position of the end effector 702 to the control circuit 710.
In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or links, 742a, 742b. These articulation members 742a, 742b are driven by separate disks on the robot interface (the rack) which are driven by the two motors 708d, 708e. When the separate firing motor 704a is provided, each of articulation links 742a, 742b can be antagonistically driven with respect to the other link in order to provide a resistive holding motion and a load to the head when it is not moving and to provide an articulation motion as the head is articulated. The articulation members 742a, 742b attach to the head at a fixed radius as the head is rotated. Accordingly, the mechanical advantage of the push-and-pull link changes as the head is rotated. This change in the mechanical advantage may be more pronounced with other articulation link drive systems.
In one aspect, the one or more motors 704a-704e may comprise a brushed DC motor with a gearbox and mechanical links to a firing member, closure member, or articulation member. Another example includes electric motors 704a-704e that operate the movable mechanical elements such as the displacement member, articulation links, closure tube, and shaft. An outside influence is an unmeasured, unpredictable influence of things like tissue, surrounding bodies, and friction on the physical system. Such outside influence can be referred to as drag, which acts in opposition to one of electric motors 704a-704e. The outside influence, such as drag, may cause the operation of the physical system to deviate from a desired operation of the physical system.
In one aspect, the position sensor 734 may be implemented as an absolute positioning system. In one aspect, the position sensor 734 may comprise a magnetic rotary absolute positioning system implemented as an AS5055EQFT single-chip magnetic rotary position sensor available from Austria Microsystems, AG. The position sensor 734 may interface with the control circuit 710 to provide an absolute positioning system. The position may include multiple Hall-effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit-by-digit method and Volder's algorithm, that is provided to implement a simple and efficient algorithm to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bitshift, and table lookup operations.
In one aspect, the control circuit 710 may be in communication with one or more sensors 738. The sensors 738 may be positioned on the end effector 702 and adapted to operate with the robotic surgical instrument 700 to measure the various derived parameters such as the gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensors 738 may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector 702. The sensors 738 may include one or more sensors. The sensors 738 may be located on the staple cartridge 718 deck to determine tissue location using segmented electrodes. The torque sensors 744a-744e may be configured to sense force such as firing force, closure force, and/or articulation force, among others. Accordingly, the control circuit 710 can sense (1) the closure load experienced by the distal closure tube and its position, (2) the firing member at the rack and its position, (3) what portion of the staple cartridge 718 has tissue on it, and (4) the load and position on both articulation rods.
In one aspect, the one or more sensors 738 may comprise a strain gauge, such as a micro-strain gauge, configured to measure the magnitude of the strain in the anvil 716 during a clamped condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensors 738 may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 716 and the staple cartridge 718. The sensors 738 may be configured to detect impedance of a tissue section located between the anvil 716 and the staple cartridge 718 that is indicative of the thickness and/or fullness of tissue located therebetween.
In one aspect, the sensors 738 may be implemented as one or more limit switches, electromechanical devices, solid-state switches, Hall-effect devices, magneto-resistive (MR) devices, giant magneto-resistive (GMR) devices, magnetometers, among others. In other implementations, the sensors 738 may be implemented as solid-state switches that operate under the influence of light, such as optical sensors, IR sensors, ultraviolet sensors, among others. Still, the switches may be solid-state devices such as transistors (e.g., FET, junction FET, MOSFET, bipolar, and the like). In other implementations, the sensors 738 may include electrical conductorless switches, ultrasonic switches, accelerometers, and inertial sensors, among others.
In one aspect, the sensors 738 may be configured to measure forces exerted on the anvil 716 by the closure drive system. For example, one or more sensors 738 can be at an interaction point between the closure tube and the anvil 716 to detect the closure forces applied by the closure tube to the anvil 716. The forces exerted on the anvil 716 can be representative of the tissue compression experienced by the tissue section captured between the anvil 716 and the staple cartridge 718. The one or more sensors 738 can be positioned at various interaction points along the closure drive system to detect the closure forces applied to the anvil 716 by the closure drive system. The one or more sensors 738 may be sampled in real time during a clamping operation by the processor of the control circuit 710. The control circuit 710 receives real-time sample measurements to provide and analyze time-based information and assess, in real time, closure forces applied to the anvil 716.
In one aspect, a current sensor 736 can be employed to measure the current drawn by each of the motors 704a-704e. The force required to advance any of the movable mechanical elements such as the I-beam 714 corresponds to the current drawn by one of the motors 704a-704e. The force is converted to a digital signal and provided to the control circuit 710. The control circuit 710 can be configured to simulate the response of the actual system of the instrument in the software of the controller. A displacement member can be actuated to move an I-beam 714 in the end effector 702 at or near a target velocity. The robotic surgical instrument 700 can include a feedback controller, which can be one of any feedback controllers, including, but not limited to a PID, a state feedback, a linear-quadratic (LQR), and/or an adaptive controller, for example. The robotic surgical instrument 700 can include a power source to convert the signal from the feedback controller into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example. Additional details are disclosed in U.S. patent application Ser. No. 15/636,829, titled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed Jun. 29, 2017, which is herein incorporated by reference in its entirety.
The position, movement, displacement, and/or translation of a linear displacement member, such as the I-beam 764, can be measured by an absolute positioning system, sensor arrangement, and position sensor 784. Because the I-beam 764 is coupled to a longitudinally movable drive member, the position of the I-beam 764 can be determined by measuring the position of the longitudinally movable drive member employing the position sensor 784. Accordingly, in the following description, the position, displacement, and/or translation of the I-beam 764 can be achieved by the position sensor 784 as described herein. A control circuit 760 may be programmed to control the translation of the displacement member, such as the I-beam 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the processor or processors to control the displacement member, e.g., the I-beam 764, in the manner described. In one aspect, a timer/counter 781 provides an output signal, such as the elapsed time or a digital count, to the control circuit 760 to correlate the position of the I-beam 764 as determined by the position sensor 784 with the output of the timer/counter 781 such that the control circuit 760 can determine the position of the I-beam 764 at a specific time (t) relative to a starting position. The timer/counter 781 may be configured to measure elapsed time, count external events, or time external events.
The control circuit 760 may generate a motor set point signal 772. The motor set point signal 772 may be provided to a motor controller 758. The motor controller 758 may comprise one or more circuits configured to provide a motor drive signal 774 to the motor 754 to drive the motor 754 as described herein. In some examples, the motor 754 may be a brushed DC electric motor. For example, the velocity of the motor 754 may be proportional to the motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor and the motor drive signal 774 may comprise a PWM signal provided to one or more stator windings of the motor 754. Also, in some examples, the motor controller 758 may be omitted, and the control circuit 760 may generate the motor drive signal 774 directly.
The motor 754 may receive power from an energy source 762. The energy source 762 may be or include a battery, a super capacitor, or any other suitable energy source. The motor 754 may be mechanically coupled to the I-beam 764 via a transmission 756. The transmission 756 may include one or more gears or other linkage components to couple the motor 754 to the I-beam 764. A position sensor 784 may sense a position of the I-beam 764. The position sensor 784 may be or include any type of sensor that is capable of generating position data that indicate a position of the I-beam 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the I-beam 764 translates distally and proximally. The control circuit 760 may track the pulses to determine the position of the I-beam 764. Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals indicating motion of the I-beam 764. Also, in some examples, the position sensor 784 may be omitted. Where the motor 754 is a stepper motor, the control circuit 760 may track the position of the I-beam 764 by aggregating the number and direction of steps that the motor 754 has been instructed to execute. The position sensor 784 may be located in the end effector 752 or at any other portion of the instrument.
The control circuit 760 may be in communication with one or more sensors 788. The sensors 788 may be positioned on the end effector 752 and adapted to operate with the surgical instrument 750 to measure the various derived parameters such as gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensors 788 may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector 752. The sensors 788 may include one or more sensors.
The one or more sensors 788 may comprise a strain gauge, such as a micro-strain gauge, configured to measure the magnitude of the strain in the anvil 766 during a clamped condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensors 788 may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The sensors 788 may be configured to detect impedance of a tissue section located between the anvil 766 and the staple cartridge 768 that is indicative of the thickness and/or fullness of tissue located therebetween.
The sensors 788 may be is configured to measure forces exerted on the anvil 766 by a closure drive system. For example, one or more sensors 788 can be at an interaction point between a closure tube and the anvil 766 to detect the closure forces applied by a closure tube to the anvil 766. The forces exerted on the anvil 766 can be representative of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various interaction points along the closure drive system to detect the closure forces applied to the anvil 766 by the closure drive system. The one or more sensors 788 may be sampled in real time during a clamping operation by a processor of the control circuit 760. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and assess, in real time, closure forces applied to the anvil 766.
A current sensor 786 can be employed to measure the current drawn by the motor 754. The force required to advance the I-beam 764 corresponds to the current drawn by the motor 754. The force is converted to a digital signal and provided to the control circuit 760.
The control circuit 760 can be configured to simulate the response of the actual system of the instrument in the software of the controller. A displacement member can be actuated to move an I-beam 764 in the end effector 752 at or near a target velocity. The surgical instrument 750 can include a feedback controller, which can be one of any feedback controllers, including, but not limited to a PID, a state feedback, LQR, and/or an adaptive controller, for example. The surgical instrument 750 can include a power source to convert the signal from the feedback controller into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example.
The actual drive system of the surgical instrument 750 is configured to drive the displacement member, cutting member, or I-beam 764, by a brushed DC motor with gearbox and mechanical links to an articulation and/or knife system. Another example is the electric motor 754 that operates the displacement member and the articulation driver, for example, of an interchangeable shaft assembly. An outside influence is an unmeasured, unpredictable influence of things like tissue, surrounding bodies and friction on the physical system. Such outside influence can be referred to as drag which acts in opposition to the electric motor 754. The outside influence, such as drag, may cause the operation of the physical system to deviate from a desired operation of the physical system.
Various example aspects are directed to a surgical instrument 750 comprising an end effector 752 with motor-driven surgical stapling and cutting implements. For example, a motor 754 may drive a displacement member distally and proximally along a longitudinal axis of the end effector 752. The end effector 752 may comprise a pivotable anvil 766 and, when configured for use, a staple cartridge 768 positioned opposite the anvil 766. A clinician may grasp tissue between the anvil 766 and the staple cartridge 768, as described herein. When ready to use the instrument 750, the clinician may provide a firing signal, for example by depressing a trigger of the instrument 750. In response to the firing signal, the motor 754 may drive the displacement member distally along the longitudinal axis of the end effector 752 from a proximal stroke begin position to a stroke end position distal of the stroke begin position. As the displacement member translates distally, an I-beam 764 with a cutting element positioned at a distal end, may cut the tissue between the staple cartridge 768 and the anvil 766.
In various examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the I-beam 764, for example, based on one or more tissue conditions. The control circuit 760 may be programmed to sense tissue conditions, such as thickness, either directly or indirectly, as described herein. The control circuit 760 may be programmed to select a firing control program based on tissue conditions. A firing control program may describe the distal motion of the displacement member. Different firing control programs may be selected to better treat different tissue conditions. For example, when thicker tissue is present, the control circuit 760 may be programmed to translate the displacement member at a lower velocity and/or with lower power. When thinner tissue is present, the control circuit 760 may be programmed to translate the displacement member at a higher velocity and/or with higher power.
In some examples, the control circuit 760 may initially operate the motor 754 in an open loop configuration for a first open loop portion of a stroke of the displacement member. Based on a response of the instrument 750 during the open loop portion of the stroke, the control circuit 760 may select a firing control program. The response of the instrument may include, a translation distance of the displacement member during the open loop portion, a time elapsed during the open loop portion, energy provided to the motor 754 during the open loop portion, a sum of pulse widths of a motor drive signal, etc. After the open loop portion, the control circuit 760 may implement the selected firing control program for a second portion of the displacement member stroke. For example, during the closed loop portion of the stroke, the control circuit 760 may modulate the motor 754 based on translation data describing a position of the displacement member in a closed loop manner to translate the displacement member at a constant velocity. Additional details are disclosed in U.S. patent application Ser. No. 15/720,852, titled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed Sep. 29, 2017, which is herein incorporated by reference in its entirety.
In one aspect, sensors 788 may be implemented as a limit switch, electromechanical device, solid-state switches, Hall-effect devices, MR devices, GMR devices, magnetometers, among others. In other implementations, the sensors 638 may be solid-state switches that operate under the influence of light, such as optical sensors, IR sensors, ultraviolet sensors, among others. Still, the switches may be solid-state devices such as transistors (e.g., FET, junction FET, MOSFET, bipolar, and the like). In other implementations, the sensors 788 may include electrical conductorless switches, ultrasonic switches, accelerometers, and inertial sensors, among others.
In one aspect, the position sensor 784 may be implemented as an absolute positioning system comprising a magnetic rotary absolute positioning system implemented as an AS5055EQFT single-chip magnetic rotary position sensor available from Austria Microsystems, AG. The position sensor 784 may interface with the control circuit 760 to provide an absolute positioning system. The position may include multiple Hall-effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit-by-digit method and Volder's algorithm, that is provided to implement a simple and efficient algorithm to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bitshift, and table lookup operations.
In one aspect, the I-beam 764 may be implemented as a knife member comprising a knife body that operably supports a tissue cutting blade thereon and may further include anvil engagement tabs or features and channel engagement features or a foot. In one aspect, the staple cartridge 768 may be implemented as a standard (mechanical) surgical fastener cartridge. In one aspect, the RF cartridge 796 may be implemented as an RF cartridge. These and other sensors arrangements are described in commonly owned U.S. patent application Ser. No. 15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is herein incorporated by reference in its entirety.
The position, movement, displacement, and/or translation of a linear displacement member, such as the I-beam 764, can be measured by an absolute positioning system, sensor arrangement, and position sensor represented as position sensor 784. Because the I-beam 764 is coupled to the longitudinally movable drive member, the position of the I-beam 764 can be determined by measuring the position of the longitudinally movable drive member employing the position sensor 784. Accordingly, in the following description, the position, displacement, and/or translation of the I-beam 764 can be achieved by the position sensor 784 as described herein. A control circuit 760 may be programmed to control the translation of the displacement member, such as the I-beam 764, as described herein. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the processor or processors to control the displacement member, e.g., the I-beam 764, in the manner described. In one aspect, a timer/counter 781 provides an output signal, such as the elapsed time or a digital count, to the control circuit 760 to correlate the position of the I-beam 764 as determined by the position sensor 784 with the output of the timer/counter 781 such that the control circuit 760 can determine the position of the I-beam 764 at a specific time (t) relative to a starting position. The timer/counter 781 may be configured to measure elapsed time, count external events, or time external events.
The control circuit 760 may generate a motor set point signal 772. The motor set point signal 772 may be provided to a motor controller 758. The motor controller 758 may comprise one or more circuits configured to provide a motor drive signal 774 to the motor 754 to drive the motor 754 as described herein. In some examples, the motor 754 may be a brushed DC electric motor. For example, the velocity of the motor 754 may be proportional to the motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor and the motor drive signal 774 may comprise a PWM signal provided to one or more stator windings of the motor 754. Also, in some examples, the motor controller 758 may be omitted, and the control circuit 760 may generate the motor drive signal 774 directly.
The motor 754 may receive power from an energy source 762. The energy source 762 may be or include a battery, a super capacitor, or any other suitable energy source. The motor 754 may be mechanically coupled to the I-beam 764 via a transmission 756. The transmission 756 may include one or more gears or other linkage components to couple the motor 754 to the I-beam 764. A position sensor 784 may sense a position of the I-beam 764. The position sensor 784 may be or include any type of sensor that is capable of generating position data that indicate a position of the I-beam 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the I-beam 764 translates distally and proximally. The control circuit 760 may track the pulses to determine the position of the I-beam 764. Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals indicating motion of the I-beam 764. Also, in some examples, the position sensor 784 may be omitted. Where the motor 754 is a stepper motor, the control circuit 760 may track the position of the I-beam 764 by aggregating the number and direction of steps that the motor has been instructed to execute. The position sensor 784 may be located in the end effector 792 or at any other portion of the instrument.
The control circuit 760 may be in communication with one or more sensors 788. The sensors 788 may be positioned on the end effector 792 and adapted to operate with the surgical instrument 790 to measure the various derived parameters such as gap distance versus time, tissue compression versus time, and anvil strain versus time. The sensors 788 may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector 792. The sensors 788 may include one or more sensors.
The one or more sensors 788 may comprise a strain gauge, such as a micro-strain gauge, configured to measure the magnitude of the strain in the anvil 766 during a clamped condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. The sensors 788 may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The sensors 788 may be configured to detect impedance of a tissue section located between the anvil 766 and the staple cartridge 768 that is indicative of the thickness and/or fullness of tissue located therebetween.
The sensors 788 may be is configured to measure forces exerted on the anvil 766 by the closure drive system. For example, one or more sensors 788 can be at an interaction point between a closure tube and the anvil 766 to detect the closure forces applied by a closure tube to the anvil 766. The forces exerted on the anvil 766 can be representative of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various interaction points along the closure drive system to detect the closure forces applied to the anvil 766 by the closure drive system. The one or more sensors 788 may be sampled in real time during a clamping operation by a processor portion of the control circuit 760. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and assess, in real time, closure forces applied to the anvil 766.
A current sensor 786 can be employed to measure the current drawn by the motor 754. The force required to advance the I-beam 764 corresponds to the current drawn by the motor 754. The force is converted to a digital signal and provided to the control circuit 760.
An RF energy source 794 is coupled to the end effector 792 and is applied to the RF cartridge 796 when the RF cartridge 796 is loaded in the end effector 792 in place of the staple cartridge 768. The control circuit 760 controls the delivery of the RF energy to the RF cartridge 796.
Additional details are disclosed in U.S. patent application Ser. No. 15/636,096, titled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed Jun. 28, 2017, which is herein incorporated by reference in its entirety.
For example, as shown in the stroke length graph 20740, the stroke length of the closure tube assembly to close the jaws is approximately 0.250 inches when the end effector is not articulated, and the compensated stroke length is approximately 0.242 inches when the articulation angle θ is approximately 60 degrees. Such measurements are provided as examples only and can include any of a variety of angles and corresponding stroke lengths and compensated stroke lengths without departing from the scope of this disclosure. Furthermore, the relationship between the articulation angles θ and compensated stroke lengths is non-linear and the rate at which the compensated stroke length shortens increases as the articulation angle increases. For example, the decrease in compensated stroke lengths between 45 degrees and 60 degrees articulation is greater than the decrease in compensated stroke lengths between zero degrees and 15 degrees articulation. Although with this approach the control system is adjusting the stroke length based on the articulation angle θ to prevent damage to the surgical device (e.g., jamming the distal end of the closure tube assembly in a distal position), the distal closure tube is still allowed to advance during articulation, thereby potentially at least partly closing the jaws.
For example, as shown in the closure tube assembly positioning graph 20750, the compensation distance when the end effector is not articulated is zero and the compensation distance when the articulation angle θ is approximately 60 degrees is approximately 0.008 inches. In this example, the closure tube assembly is retracted by a 0.008 inch compensation distance during articulation. As such, to close the jaws, the closure tube assembly can advance the stoke length starting from this retracted position. Such measurements are provided for example purposes only and can include any of a variety of angles and corresponding compensation distances without departing from the scope of the disclosure. As shown in
When clamping patient tissue, forces exerted through the clamping device, e.g., a linear stapler, and the tissue may reach an unacceptably high level. For example, when a constant closure rate is employed, the force may become high enough to cause excess trauma to the clamped tissue and may cause deformation in the clamping device such that an acceptable tissue gap is not maintained across the stapling path.
In
The limiting of power is achieved in the example with CTC by slowing the closing rate, as illustrated by line 20760. It is noted that the compression time B′ is longer than the closing time B. As illustrated in
In some aspects, a control system can include a plurality of predefined force thresholds that assist the control system in determining a position of an E-beam and/or articulation angle of a firing shaft and appropriately controlling at least one motor based on such determination. For example, the force thresholds can change depending on a length of travel of the firing bar configured to translate the firing shaft, and such force thresholds can be compared to a measured torsional force of the one or more motors in communication with the control system. Comparison of the measured torsional forces against the force thresholds can provide a dependable way for the control system to determine a location of the E-beam and/or articulation of the end effector. This can allow the control system to appropriately control the one or more motors (e.g., reduce or stop torsional loads) to ensure proper firing of the firing assembly and articulation of the end effector, as well as prevent against damage to the system, as will be described in greater detail below.
After the firing bar advances past the articulation range 20902, a shifting mechanism within the surgical stapler can cause further distal travel of the firing bar to cause distal travel of the firing shaft. For example, as shown in section B, travel between approximately 12 mm and 70 mm of travel displacement can cause the E-beam to advance along a firing stroke 20904 and cut tissue captured between the jaws, however, other lengths of travel are within the scope of this disclosure. In this example, a maximum firing stroke position 20906 of the E-beam occurs at 70 mm travel. At this point, the E-beam or knife abuts a distal end of the cartridge or jaw thereby increasing torsional forces on the motor and causing a knife travel force peak 20806, as shown in section A, to be sensed by the control system. As shown in section A, the control system can include a motor threshold 20808 and an end of knife travel threshold 20810 that branches off from the motor threshold 20808 and decreases (e.g., non-linearly) as the E-beam approaches the maximum firing stroke position 20906.
The control system can be configured to monitor the sensed motor torsional force during at least the last part of distal travel 20907 (e.g., last 10 percent of the firing stroke 904) of the E-beam before reaching the maximum firing stroke position 20906. While monitoring along such last part of distal travel 20907, the control system can cause the motor to reduce torsional forces to thereby reduce the load on the E-beam. This can protect damage to the surgical stapler, including the E-beam, by reducing loads on the E-beam as the E-beam approaches the maximum firing stroke position 20906 thereby reducing impact of the E-beam against the distal end of the cartridge or jaw. As mentioned above, such impact can cause a knife travel force peak 20806, which can exceed the knife travel threshold 20810 but not the motor threshold 20808 thereby not damaging the motor. As such, the control system can stop actuation of the motor after the knife travel force peak 20806 exceeds the knife travel threshold 20810 and before the knife travel force peak 20806 exceeds the motor threshold 20808 thereby protecting the motor from damage. Furthermore, the increasing reduction in the knife travel threshold 20810 prevents the control system from preliminarily thinking that the E-beam has reached the maximum firing stroke position 20906.
After the control system has detected a knife travel force peak 20806 exceeding the knife travel threshold 20810, the control system can confirm a position of the E-beam (e.g., at 70 mm displacement and/or at end of firing stroke 20904) and can retract the firing bar based on such known displacement position to reset the E-beam in a most proximal position 20908 (e.g., 0 mm displacement). At the most proximal position 20908, a knife retraction force peak 20812 that exceeds a predefined knife retraction threshold 20814, as shown in section A, can be sensed by the control system. At this point, the control system can recalibrate, if needed, and associate the position of the E-beam as being in a home position where subsequent advancement of the firing rod in the distal direction (e.g., approximately 12 mm in length) will cause the shifter to disengage the E-beam from the firing bar. Once disengaged, firing bar travel within the articulation range 20902 will again cause articulation of the end effector.
As such, the control system can sense torsional forces on the motor controlling travel of the firing bar and compare such sensed torsional forces against a plurality of thresholds to determine a position of the E-beam or angle of articulation of the end effector and thereby appropriately control the motor to prevent damage to the motor, as well as confirm positioning of the firing bar and/or E-beam.
As described supra, tissue contact or pressure sensors determine when the jaw members initially come into contact with the tissue “T”. This enables a surgeon to determine the initial thickness of the tissue “T” and/or the thickness of the tissue “T” prior to clamping. In any of the surgical instrument aspects described above, as seen in
Any of the contact sensors disclosed herein may include, and are not limited to, electrical contacts placed on an inner surface of a jaw which, when in contact with tissue, close a sensing circuit that is otherwise open. The contact sensors may also include sensitive force transducers that detect when the tissue being clamped first resists compression. Force transducers may include, and are not limited to, piezoelectric elements, piezoresistive elements, metal film or semiconductor strain gauges, inductive pressure sensors, capacitive pressure sensors, and potentiometric pressure transducers that use bourbon tubes, capsules or bellows to drive a wiper arm on a resistive element.
In an aspect, any one of the aforementioned surgical instruments may include one or more piezoelectric elements to detect a change in pressure occurring on the jaw members. Piezoelectric elements are bi-directional transducers which convert stress into an electrical potential. Elements may consist of metallized quartz or ceramics. In operation, when stress is applied to the crystals there is a change in the charge distribution of the material resulting in a generation of voltage across the material. Piezoelectric elements may be used to indicate when any one or both of the jaw members makes contact with the tissue “T” and the amount of pressure exerted on the tissue “T” after contact is established.
In an aspect, any one of the aforementioned surgical instruments may include or be provided with one or more metallic strain gauges placed within or upon a portion of the body thereof. Metallic strain gauges operate on the principle that the resistance of the material depends upon length, width and thickness. Accordingly, when the material of the metallic strain gauge undergoes strain the resistance of the material changes. Thus, a resistor made of this material incorporated into a circuit will convert strain to a change in an electrical signal. Desirably, the strain gauge may be placed on the surgical instruments such that pressure applied to the tissue effects the strain gauge.
Alternatively, in another aspect, one or more semiconductor strain gauges may be used in a similar manner as the metallic strain gauge described above, although the mode of transduction differs. In operation, when a crystal lattice structure of the semiconductor strain gauge is deformed, as a result of an applied stress, the resistance of the material changes. This phenomenon is referred to as the piezoresistive effect.
In yet another aspect, any one of the aforementioned surgical instruments may include or be provided with one or more inductive pressure sensors to transduce pressure or force into motion of inductive elements relative to each other. This motion of the inductive elements relative to one another alters the overall inductance or inductive coupling. Capacitive pressure transducers similarly transduce pressure or force into motion of capacitive elements relative to each other altering the overall capacitance.
In still another aspect, any one of the aforementioned surgical instruments may include or be provided with one or more capacitive pressure transducers to transduce pressure or force into motion of capacitive elements relative to each other altering an overall capacitance.
In an aspect, any one of the aforementioned surgical instruments may include or be provided with one or more mechanical pressure transducers to transduce pressure or force into motion. In use, a motion of a mechanical element is used to deflect a pointer or dial on a gauge. This movement of the pointer or dial may be representative of the pressure or force applied to the tissue “T”. Examples of mechanical elements include and are not limited to bourbon tubes, capsules or bellows. By way of example, mechanical elements may be coupled with other measuring and/or sensing elements, such as a potentiometer pressure transducer. In this example the mechanical element is coupled with a wiper on the variable resistor. In use, pressure or force may be transduced into mechanical motion which deflects the wiper on the potentiometer thus changing the resistance to reflect the applied pressure or force.
The combination of the above aspects, in particular the combination of the gap and tissue contact sensors, provides the surgeon with feedback information and/or real-time information regarding the condition of the operative site and/or target tissue “T”. For example, information regarding the initial thickness of the tissue “T” may guide the surgeon in selecting an appropriate staple size, information regarding the clamped thickness of the tissue “T” may let the surgeon know if the selected staple will form properly, information relating to the initial thickness and clamped thickness of the tissue “T” may be used to determine the amount of compression or strain on the tissue “T”, and information relating to the strain on the tissue “T” may be used this strain to avoid compressing tissue to excessive strain values and/or stapling into tissue that has undergone excessive strain.
Additionally, force sensors may be used to provide the surgeon with the amount of pressure applied to the tissue. The surgeon may use this information to avoid applying excessive pressure on the tissue “T” or stapling into tissue “T” which has experienced excessive strain.
Certain aspects are shown and described to provide an understanding of the structure, function, manufacture, and use of the disclosed devices and methods. Features shown or described in one example may be combined with features of other examples and modifications and variations are within the scope of this disclosure.
The terms “proximal” and “distal” are relative to a clinician manipulating the handle of the surgical instrument where “proximal” refers to the portion closer to the clinician and “distal” refers to the portion located further from the clinician. For expediency, spatial terms “vertical,” “horizontal,” “up,” and “down” used with respect to the drawings are not intended to be limiting and/or absolute, because surgical instruments can used in many orientations and positions.
Example devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. Such devices and methods, however, can be used in other surgical procedures and applications including open surgical procedures, for example. The surgical instruments can be inserted into a through a natural orifice or through an incision or puncture hole formed in tissue. The working portions or end effector portions of the instruments can be inserted directly into the body or through an access device that has a working channel through which the end effector and elongated shaft of the surgical instrument can be advanced.
The handle assembly 150014 may comprise a pair of interconnectable handle housing segments 150016, 150018 interconnected by screws, snap features, adhesive, etc. The handle housing segments 150016, 150018 cooperate to form a pistol grip portion 150019 that can be gripped and manipulated by the clinician. The handle assembly 150014 operably supports a plurality of drive systems configured to generate and apply control motions to corresponding portions of the interchangeable shaft assembly that is operably attached thereto. A display may be provided below a cover 150045.
The handle assembly 150014 and the frame 150020 may operably support a firing drive system 150080 configured to apply firing motions to corresponding portions of the interchangeable shaft assembly attached thereto. The firing drive system 150080 may employ an electric motor 150082 located in the pistol grip portion 150019 of the handle assembly 150014. The electric motor 150082 may be a DC brushed motor having a maximum rotational speed of approximately 25,000 RPM, for example. In other arrangements, the motor may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The electric motor 150082 may be powered by a power source 150090 that may comprise a removable power pack 150092. The removable power pack 150092 may comprise a proximal housing portion 150094 configured to attach to a distal housing portion 150096. The proximal housing portion 150094 and the distal housing portion 150096 are configured to operably support a plurality of batteries 150098 therein. Batteries 150098 may each comprise, for example, a Lithium Ion (LI) or other suitable battery. The distal housing portion 150096 is configured for removable operable attachment to a control circuit board 150100, which is operably coupled to the electric motor 150082. Several batteries 150098 connected in series may power the surgical instrument 150010. The power source 150090 may be replaceable and/or rechargeable. A display 150043, which is located below the cover 150045, is electrically coupled to the control circuit board 150100. The cover 150045 may be removed to expose the display 150043.
The electric motor 150082 can include a rotatable shaft (not shown) that operably interfaces with a gear reducer assembly 150084 mounted in meshing engagement with a with a set, or rack, of drive teeth 150122 on a longitudinally movable drive member 150120. The longitudinally movable drive member 150120 has a rack of drive teeth 150122 formed thereon for meshing engagement with a corresponding drive gear 150086 of the gear reducer assembly 150084.
In use, a voltage polarity provided by the power source 150090 can operate the electric motor 150082 in a clockwise direction wherein the voltage polarity applied to the electric motor by the battery can be reversed in order to operate the electric motor 150082 in a counter-clockwise direction. When the electric motor 150082 is rotated in one direction, the longitudinally movable drive member 150120 will be axially driven in the distal direction “DD.” When the electric motor 150082 is driven in the opposite rotary direction, the longitudinally movable drive member 150120 will be axially driven in a proximal direction “PD.” The handle assembly 150014 can include a switch that can be configured to reverse the polarity applied to the electric motor 150082 by the power source 150090. The handle assembly 150014 may include a sensor configured to detect the position of the longitudinally movable drive member 150120 and/or the direction in which the longitudinally movable drive member 150120 is being moved.
Actuation of the electric motor 150082 can be controlled by a firing trigger 150130 that is pivotally supported on the handle assembly 150014. The firing trigger 150130 may be pivoted between an unactuated position and an actuated position.
Turning back to
Turning back to
The interchangeable shaft assembly 150200 can include a clutch assembly 150400 configured to selectively and releasably couple the articulation driver 150230 to the firing member 150220. The clutch assembly 150400 includes a lock collar, or lock sleeve 150402, positioned around the firing member 150220 wherein the lock sleeve 150402 can be rotated between an engaged position in which the lock sleeve 150402 couples the articulation driver 150230 to the firing member 150220 and a disengaged position in which the articulation driver 150230 is not operably coupled to the firing member 150220. When the lock sleeve 150402 is in the engaged position, distal movement of the firing member 150220 can move the articulation driver 150230 distally and, correspondingly, proximal movement of the firing member 150220 can move the articulation driver 150230 proximally. When the lock sleeve 150402 is in the disengaged position, movement of the firing member 150220 is not transmitted to the articulation driver 150230 and, as a result, the firing member 150220 can move independently of the articulation driver 150230. The nozzle 150201 may be employed to operably engage and disengage the articulation drive system with the firing drive system in the various manners described in U.S. Patent Application Publication No. 2014/0263541.
The interchangeable shaft assembly 150200 can comprise a slip ring assembly 150600 which can be configured to conduct electrical power to and/or from the end effector 150300 and/or communicate signals to and/or from the end effector 150300, for example. The slip ring assembly 150600 can comprise a proximal connector flange 150604 and a distal connector flange 150601 positioned within a slot defined in the nozzle portions 150202, 150203. The proximal connector flange 150604 can comprise a first face and the distal connector flange 150601 can comprise a second face positioned adjacent to and movable relative to the first face. The distal connector flange 150601 can rotate relative to the proximal connector flange 150604 about the shaft axis SA-SA (
The interchangeable shaft assembly 150200 can include a proximal portion fixably mounted to the handle assembly 150014 and a distal portion that is rotatable about a longitudinal axis. The rotatable distal shaft portion can be rotated relative to the proximal portion about the slip ring assembly 150600. The distal connector flange 150601 of the slip ring assembly 150600 can be positioned within the rotatable distal shaft portion.
The I-beam 150178 can include upper pins 150180 that engage the anvil 150306 during firing. The I-beam 150178 may include middle pins 150184 and a bottom foot 150186 to engage portions of the cartridge body 150194, cartridge tray 150196, and elongated channel 150302. When a surgical staple cartridge 150304 is positioned within the elongated channel 150302, a slot 150193 defined in the cartridge body 150194 can be aligned with a longitudinal slot 150197 defined in the cartridge tray 150196 and a slot 150189 defined in the elongated channel 150302. In use, the I-beam 150178 can slide through the aligned longitudinal slots 150193, 150197, and 150189 wherein, as indicated in
The shaft assembly 150704 may include a shaft assembly controller 150722 which can communicate with a safety controller and power management controller 150716 through an interface while the shaft assembly 150704 and the power assembly 150706 are coupled to the handle assembly 150702. For example, the interface may comprise a first interface portion 150725 which may include one or more electric connectors for coupling engagement with corresponding shaft assembly electric connectors and a second interface portion 150727 which may include one or more electric connectors for coupling engagement with corresponding power assembly electric connectors to permit electrical communication between the shaft assembly controller 150722 and the power management controller 150716 while the shaft assembly 150704 and the power assembly 150706 are coupled to the handle assembly 150702. One or more communication signals can be transmitted through the interface to communicate one or more of the power requirements of the attached interchangeable shaft assembly 150704 to the power management controller 150716. In response, the power management controller may modulate the power output of the battery of the power assembly 150706, as described below in greater detail, in accordance with the power requirements of the attached shaft assembly 150704. The connectors may comprise switches which can be activated after mechanical coupling engagement of the handle assembly 150702 to the shaft assembly 150704 and/or to the power assembly 150706 to allow electrical communication between the shaft assembly controller 150722 and the power management controller 150716.
The interface can facilitate transmission of the one or more communication signals between the power management controller 150716 and the shaft assembly controller 150722 by routing such communication signals through a main controller 150717 residing in the handle assembly 150702, for example. In other circumstances, the interface can facilitate a direct line of communication between the power management controller 150716 and the shaft assembly controller 150722 through the handle assembly 150702 while the shaft assembly 150704 and the power assembly 150706 are coupled to the handle assembly 150702.
The main controller 150717 may be any single core or multicore processor such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the main controller 150717 may be an LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas Instruments, for example, comprising on-chip memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), internal read-only memory (ROM) loaded with StellarisWare® software, 2 KB electrically erasable programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more quadrature encoder inputs (QEI) analog, one or more 12-bit Analog-to-Digital Converters (ADC) with 12 analog input channels, details of which are available for the product datasheet.
The safety controller may be a safety controller platform comprising two controller-based families such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options.
The power assembly 150706 may include a power management circuit which may comprise the power management controller 150716, a power modulator 150738, and a current sense circuit 150736. The power management circuit can be configured to modulate power output of the battery based on the power requirements of the shaft assembly 150704 while the shaft assembly 150704 and the power assembly 150706 are coupled to the handle assembly 150702. The power management controller 150716 can be programmed to control the power modulator 150738 of the power output of the power assembly 150706 and the current sense circuit 150736 can be employed to monitor power output of the power assembly 150706 to provide feedback to the power management controller 150716 about the power output of the battery so that the power management controller 150716 may adjust the power output of the power assembly 150706 to maintain a desired output. The power management controller 150716 and/or the shaft assembly controller 150722 each may comprise one or more processors and/or memory units which may store a number of software modules.
The surgical instrument 150010 (
The control circuit 150700 comprises circuit segments configured to control operations of the powered surgical instrument 150010. A safety controller segment (Segment 1) comprises a safety controller and the main controller 150717 segment (Segment 2). The safety controller and/or the main controller 150717 are configured to interact with one or more additional circuit segments such as an acceleration segment, a display segment, a shaft segment, an encoder segment, a motor segment, and a power segment. Each of the circuit segments may be coupled to the safety controller and/or the main controller 150717. The main controller 150717 is also coupled to a flash memory. The main controller 150717 also comprises a serial communication interface. The main controller 150717 comprises a plurality of inputs coupled to, for example, one or more circuit segments, a battery, and/or a plurality of switches. The segmented circuit may be implemented by any suitable circuit, such as, for example, a printed circuit board assembly (PCBA) within the powered surgical instrument 150010. It should be understood that the term processor as used herein includes any microprocessor, processors, controller, controllers, or other basic computing device that incorporates the functions of a computer's central processing unit (CPU) on an integrated circuit or at most a few integrated circuits. The main controller 150717 is a multipurpose, programmable device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. It is an example of sequential digital logic, as it has internal memory. The control circuit 150700 can be configured to implement one or more of the processes described herein.
The acceleration segment (Segment 3) comprises an accelerometer. The accelerometer is configured to detect movement or acceleration of the powered surgical instrument 150010. Input from the accelerometer may be used to transition to and from a sleep mode, identify an orientation of the powered surgical instrument, and/or identify when the surgical instrument has been dropped. In some examples, the acceleration segment is coupled to the safety controller and/or the main controller 150717.
The display segment (Segment 4) comprises a display connector coupled to the main controller 150717. The display connector couples the main controller 150717 to a display through one or more integrated circuit drivers of the display. The integrated circuit drivers of the display may be integrated with the display and/or may be located separately from the display. The display may comprise any suitable display, such as, for example, an organic light-emitting diode (OLED) display, a liquid-crystal display (LCD), and/or any other suitable display. In some examples, the display segment is coupled to the safety controller.
The shaft segment (Segment 5) comprises controls for an interchangeable shaft assembly 150200 (
The position encoder segment (Segment 6) comprises one or more magnetic angle rotary position encoders. The one or more magnetic angle rotary position encoders are configured to identify the rotational position of the motor 150714, an interchangeable shaft assembly 150200 (
The motor circuit segment (Segment 7) comprises a motor 150714 configured to control movements of the powered surgical instrument 150010 (
The motor controller controls a first motor flag and a second motor flag to indicate the status and position of the motor 150714 to the main controller 150717. The main controller 150717 provides a pulse-width modulation (PWM) high signal, a PWM low signal, a direction signal, a synchronize signal, and a motor reset signal to the motor controller through a buffer. The power segment is configured to provide a segment voltage to each of the circuit segments.
The power segment (Segment 8) comprises a battery coupled to the safety controller, the main controller 150717, and additional circuit segments. The battery is coupled to the segmented circuit by a battery connector and a current sensor. The current sensor is configured to measure the total current draw of the segmented circuit. In some examples, one or more voltage converters are configured to provide predetermined voltage values to one or more circuit segments. For example, in some examples, the segmented circuit may comprise 3.3V voltage converters and/or 5V voltage converters. A boost converter is configured to provide a boost voltage up to a predetermined amount, such as, for example, up to 13V. The boost converter is configured to provide additional voltage and/or current during power intensive operations and prevent brownout or low-power conditions.
A plurality of switches are coupled to the safety controller and/or the main controller 150717. The switches may be configured to control operations of the surgical instrument 150010 (
Any suitable mechanical, electromechanical, or solid state switches may be employed to implement the plurality of switches, in any combination. For example, the switches may be limit switches operated by the motion of components associated with the surgical instrument 150010 (FIGS. 25 to 28) or the presence of an object. Such switches may be employed to control various functions associated with the surgical instrument 150010. A limit switch is an electromechanical device that consists of an actuator mechanically linked to a set of contacts. When an object comes into contact with the actuator, the device operates the contacts to make or break an electrical connection. Limit switches are used in a variety of applications and environments because of their ruggedness, ease of installation, and reliability of operation. They can determine the presence or absence, passing, positioning, and end of travel of an object. In other implementations, the switches may be solid state switches that operate under the influence of a magnetic field such as Hall-effect devices, magneto-resistive (MR) devices, giant magneto-resistive (GMR) devices, magnetometers, among others. In other implementations, the switches may be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. Still, the switches may be solid state devices such as transistors (e.g., FET, Junction-FET, metal-oxide semiconductor-FET (MOSFET), bipolar, and the like). Other switches may include wireless switches, ultrasonic switches, accelerometers, inertial sensors, among others.
The surgical instrument 150010 (
Referring to
Referring to
The compression through tissue 151032 may be determined from an impedance of tissue 151032. At various levels of compression, the impedance Z of tissue 151032 may increase or decrease. By applying a voltage V and a current I to the tissue 151032, the impedance Z of the tissue 151032 may be determined at various levels of compression. For example, impedance Z may be calculated by dividing the applied voltage V by the current I.
Referring now to
Referring now to
Referring now to
Referring now to
Referring still to
Referring now to
A voltage V and a current I associated with the one or more RF signals may be used to calculate an impedance Z associated with a tissue that may be compressed between the staple cartridge (and communicatively coupled to one or more RF electrodes 151260) and the channel frame or anvil (and communicatively coupled to one or more of electrical contacts 151264 or 151266).
In one aspect, various components of the tissue compression sensor system described herein may be located in a shaft 151258 of the surgical stapler. For example, as shown in circuit diagram 151250 (and in addition to the frequency generator 151254), an impedance calculator 151272, a controller 151274, a non-volatile memory 151276, and a communication channel 151278 may be located in the shaft 151258. In one example, the frequency generator 151254, impedance calculator 151272, controller 151274, non-volatile memory 151276, and communication channel 151278 may be positioned on a circuit board in the shaft 151258.
The two or more RF signals may be returned on a common path via the electrical contacts. Further, the two or more RF signals may be filtered prior to the joining of the RF signals on the common path to differentiate separate tissue impedances represented by the two or more RF signals. Current I1 and current I2 may be measured on a return path corresponding to electrical contacts 151264 and 151266. Using a voltage V applied between the supply and return paths, impedances Z1 and Z2 may be calculated. Z1 may correspond to an impedance of a tissue compressed and/or communicatively coupled between one or more of RF electrodes 151260 and electrical contact 151264. Further, Z2 may correspond to an impedance of the tissue compressed and/or communicatively coupled between one or more of RF electrodes 151260 and electrical contact 151266. Applying the formulas Z1=V/I1 and Z2=V/I2, impedances Z1 and Z2 corresponding to different compressions of a tissue compressed by an end-effector 151262 may be calculated. In example, the impedances Z1 and Z2 may be calculated by the impedance calculator 151272. The impedances Z1 and Z2 may be used to calculate various compression levels of the tissue.
Referring now to
In one aspect, filters 151268 and 151270 may be High Q filters such that the filter range may be narrow (e.g., Q=10). Q may be defined by the Center frequency (Wo)/Bandwidth (BW) where Q=Wo/BW. In one example, Frequency 1 may be 150 kHz and Frequency 2 may be 300 kHz. A viable impedance measurement range may be 100 kHz-20 MHz. In various examples, other sophisticated techniques, such as correlation, quadrature detection, etc., may be used to separate the RF signals.
Using one or more of the techniques and features described herein, a single energized electrode on a staple cartridge or an isolated knife of an end-effector may be used to make multiple tissue compression measurements simultaneously. If two or more RF signals are overlaid or multiplexed (or nested or modulated), they may be transmitted down a single power side of the end-effector and may return on either the channel frame or the anvil of the end-effector. If a filter were built into the anvil and channel contacts before they join a common return path, the tissue impedance represented by both paths could be differentiated. This may provide a measure of vertical tissue vs lateral tissue compression. This approach also may provide proximal and distal tissue compression depending on placement of the filters and location of the metallic return paths. A frequency generator and signal processor may be located on one or more chips on a circuit board or a sub board (which may already exist in a surgical stapler).
In one aspect, the present disclosure provides an instrument 150010 (described in connection with
The rate of change of a sensed parameter or stated otherwise, how much time is necessary for a tissue parameter to reach an asymptotic steady state value, is a separate measurement in itself and may be more valuable than the sensed parameter it was derived from. To enhance measurement of tissue parameters such as waiting a predetermined amount of time before making a measurement, the present disclosure provides a novel technique for employing the derivate of the measure such as the rate of change of the tissue parameter.
The derivative technique or rate of change measure becomes most useful with the understanding that there is no single measurement that can be employed alone to dramatically improve staple formation. It is the combination of multiple measurements that make the measurements valid. In the case of tissue gap it is helpful to know how much of the jaw is covered with tissue to make the gap measure relevant. Rate of change measures of impedance may be combined with strain measurements in the anvil to relate force and compression applied to the tissue grasped between the jaw members of the end effector such as the anvil and the staple cartridge. The rate of change measure can be employed by the endosurgical device to determine the tissue type and not merely the tissue compression. Although stomach and lung tissue sometimes have similar thicknesses, and even similar compressive properties when the lung tissue is calcified, an instrument may be able to distinguish these tissue types by employing a combination of measurements such as gap, compression, force applied, tissue contact area, and rate of change of compression or rate of change of gap. If any of these measurements were used alone, it may be difficult for the endosurgical device to distinguish one tissue type form another. Rate of change of compression also may be helpful to enable the device to determine if the tissue is “normal” or if some abnormality exists. Measuring not only how much time has passed but the variation of the sensor signals and determining the derivative of the signal would provide another measurement to enable the endosurgical device to measure the signal. Rate of change information also may be employed in determining when a steady state has been achieved to signal the next step in a process. For example, after clamping the tissue between the jaw members of the end effector such as the anvil and the staple cartridge, when tissue compression reaches a steady state (e.g., about 15 seconds), an indicator or trigger to start firing the device can be enabled.
Also provided herein are methods, devices, and systems for time dependent evaluation of sensor data to determine stability, creep, and viscoelastic characteristics of tissue during surgical instrument operation. A surgical instrument, such as the stapler illustrated in
The examples shown in connection with
Turning now to
The housing 151312 depicted in
With continued reference to
The inventors have discovered that derived parameters can be even more useful for controlling a surgical instrument, such as the instrument illustrated in
For example, stomach and lung tissue can be differentiated even though these tissue can have similar thicknesses, and can have similar compressive properties if the lung tissue is calcified. Stomach and lung tissues can be distinguished by analyzing jaw gap distance, tissue compression, force applied, tissue contact area, compression rate of change, and jaw gap rate of change. For example,
Compression rate of change also can enable the microcontroller to determine if the tissue is “normal” or if some abnormality exists, such as calcification. For example, referring to
In addition, certain sensed measurements may benefit from additional sensory input. For example, in the case of jaw gap, knowing how much of the jaw is covered with tissue can make the gap measurement more useful and accurate. If a small portion of the jaw is covered in tissue, tissue compression may appear to be less than if the entire jaw is covered in tissue. Thus, the amount of jaw coverage can be taken into account by the microcontroller when analyzing tissue compression and other sensed parameters.
In certain circumstances, elapsed time also can be an important parameter. Measuring how much time has passed, together with sensed parameters, and derivative parameters (e.g., rate of change) provides further useful information. For example, if jaw gap rate of change remains constant after a set period of time (e.g., 5 seconds), then the parameter may have reached its asymptotic value.
Rate of change information also is useful in determining when a steady state has been achieved, thus signaling a next step in a process. For example, during clamping, when tissue compression reaches a steady state—e.g., no significant rate of change occurs after a set period of time—the microcontroller can send a signal to the display alerting the clinician to start the next step in the operation, such as staple firing. Alternatively, the microcontroller can be programmed to automatically start the next stage of operation (e.g., staple firing) once a steady state is reached.
Similarly, impedance rate of change can be combined with strain in the anvil to relate force and compression. The rate of change would allow the device to determine the tissue type rather than merely measure the compression value. For example, stomach and lung sometimes have similar thicknesses, and even similar compressive properties if the lung is calcified.
The combination of one or more sensed parameters with derived parameters provides more reliable and accurate assessment of tissue types and tissue health, and allows for better device monitoring, control, and clinician feedback.
The end effector 152000 comprises a second sensor 152008b. The second sensor 152008b is configured to measure one or more parameters of the end effector 152000. For example, in various embodiments, the second sensor 152008b may comprise a strain gauge configured to measure the magnitude of the strain in the anvil 152002 during a clamped condition. The strain gauge provides an electrical signal whose amplitude varies with the magnitude of the strain. In various embodiments, the first sensor 152008a and/or the second sensor 152008b may comprise, for example, a magnetic sensor such as, for example, a Hall effect sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as, for example, an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector 152000. The first sensor 152008a and the second sensor 152008b may be arranged in a series configuration and/or a parallel configuration. In a series configuration, the second sensor 152008b may be configured to directly affect the output of the first sensor 152008a. In a parallel configuration, the second sensor 152008b may be configured to indirectly affect the output of the first sensor 152008a.
In one embodiment, the one or more parameters measured by the first sensor 152008a are related to the one or more parameters measured by the second sensor 152008b. For example, in one embodiment, the first sensor 152008a is configured to measure the gap 152010 between the anvil 152002 and the second jaw member 152004. The gap 152010 is representative of the thickness and/or compressibility of a tissue section clamped between the anvil 152002 and the staple cartridge 152006. The first sensor 152008a may comprise, for example, a Hall effect sensor configured to detect a magnetic field generated by the magnet 152012 coupled to the second jaw member 152004 and/or the staple cartridge 152006. Measuring at a single location accurately describes the compressed tissue thickness for a calibrated full bit of tissue, but may provide inaccurate results when a partial bite of tissue is placed between the anvil 152002 and the second jaw member 152004. A partial bite of tissue, either a proximal partial bite or a distal partial bite, changes the clamping geometry of the anvil 152002.
In some embodiments, the second sensor 152008b is configured to detect one or more parameters indicative of a type of tissue bite, for example, a full bite, a partial proximal bite, and/or a partial distal bite. The measurement of the second sensor 152008b may be used to adjust the measurement of the first sensor 152008a to accurately represent a proximal or distal positioned partial bite's true compressed tissue thickness. For example, in one embodiment, the second sensor 152008b comprises a strain gauge, such as, for example, a micro-strain gauge, configured to monitor the amplitude of the strain in the anvil during a clamped condition. The amplitude of the strain of the anvil 152002 is used to modify the output of the first sensor 152008a, for example, a Hall effect sensor, to accurately represent a proximal or distal positioned partial bite's true compressed tissue thickness. The first sensor 152008a and the second sensor 152008b may be measured in real-time during a clamping operation. Real-time measurement allows time based information to be analyzed, for example, by a primary processor (e.g., processor 462 (
In some embodiments, the thickness measurement of the first sensor 152008a may be provided to an output device of a surgical instrument 150010 coupled to the end effector 152000. For example, in one embodiment, the end effector 152000 is coupled to the surgical instrument 150010 comprising a display (e.g., display 473 (
In some embodiments, the first sensor 152008a and the second sensor 152008b may be located in different environments, such as, for example, the first sensor 152008a being located within a patient at a treatment site and the second sensor 152008b being located externally to the patient. The second sensor 152008b may be configured to calibrate and/or modify the output of the first sensor 152008a. The first sensor 152008a and/or the second sensor 152008b may comprise, for example, an environmental sensor. Environmental sensors may comprise, for example, temperature sensors, humidity sensors, pressure sensors, and/or any other suitable environmental sensor.
In some embodiments, the surgical instrument can further comprise a load cell or sensor 152082. The load sensor 152082 can be located, for instance, in the shaft assembly 150200, described above, or in the housing 150012, also described above.
In some embodiments, the end effector 152100 comprises a second sensor 152108b. The second sensor 152108b is coupled to second jaw member 152104 and/or the staple cartridge 152106. The second sensor 152108b is configured to detect one or more parameters of the end effector 152100. For example, in some embodiments, the second sensor 152108b is configured to detect one or more instrument conditions such as, for example, a color of the staple cartridge 152106 coupled to the second jaw member 152104, a length of the staple cartridge 152106, a clamping condition of the end effector 152100, the number of uses/number of remaining uses of the end effector 152100 and/or the staple cartridge 152106, and/or any other suitable instrument condition. The second sensor 152108b may comprise any suitable sensor for detecting one or more instrument conditions, such as, for example, a magnetic sensor, such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor, such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor.
The end effector 152100 may be used in conjunction with any of the processes shown in
In some embodiments, the end effector 152150 comprises a plurality of secondary sensors 152160a, 152160b. The secondary sensors 152160a, 152160b are configured to detect one or more parameters of the end effector 152150. For example, in some embodiments, the secondary sensors 152160a, 152160b are configured to measure an amplitude of strain exerted on the anvil 152152 during a clamping procedure. In various embodiments, the secondary sensors 152160a, 152160b may comprise a magnetic sensor, such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor, such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor. The secondary sensors 152160a, 152160b may be configured to measure one or more identical parameters at different locations of the anvil 152152, different parameters at identical locations on the anvil 152152, and/or different parameters at different locations on the anvil 152152.
In some embodiments, a plurality of secondary sensors 152160a, 152160b are coupled to a plurality of bridges 152192a, 152192b within the circuit 152190. The plurality of bridges 152192a, 152192b may provide filtering of the input from the plurality of secondary sensors 152160a, 152160b. After filtering the input signals, the plurality of bridges 152192a, 152192b provide the inputs from the plurality of secondary sensors 152160a, 152160b to the analog-to-digital convertor 152194. In some embodiments, a switch 152198 coupled to one or more level shifting resistors may be coupled to the analog-to-digital convertor 152194. The switch 152198 is configured to calibrate one or more of the input signals, such as, for example, an input from a Hall effect sensor. The switch 152198 may be engaged to provide one or more level shifting signals to adjust the input of one or more of the sensors, such as, for example, to calibrate the input of a Hall effect sensor. In some embodiments, the adjustment is not necessary, and the switch 152198 is left in the open position to decouple the level shifting resistors. The switch 152198 is coupled to the analog-to-digital convertor 152194. The analog-to-digital convertor 152194 provides an output to one or more processors, such as, for example, the primary processor. The primary processor calculates one or more parameters of the end effector 152150 based on the input from the analog-to-digital convertor 152194. For example, in one embodiment, the primary processor calculates a thickness of tissue located between the anvil 152152 and the staple cartridge 152156 based on input from one or more sensors 152158, 152160a, 152160b.
In one embodiment, the plurality of sensors 152208a-152208d allows a robust tissue thickness sensing process to be implemented. By detecting various parameters along the length of the anvil 152202, the plurality of sensors 152208a-152208d allow a surgical instrument, such as, for example, the surgical instrument 150010, to calculate the tissue thickness in the jaws regardless of the bite, for example, a partial or full bite. In some embodiments, the plurality of sensors 152208a-152208d comprises a plurality of strain gauges. The plurality of strain gauges is configured to measure the strain at various points on the anvil 152202. The amplitude and/or the slope of the strain at each of the various points on the anvil 152202 can be used to determine the thickness of tissue in between the anvil 152202 and the staple cartridge 152206. The plurality of strain gauges may be configured to optimize maximum amplitude and/or slope differences based on clamping dynamics to determine thickness, tissue placement, and/or material properties of the tissue. Time based monitoring of the plurality of sensors 152208a-152208d during clamping allows a processor, such as, for example, the primary processor, to utilize algorithms and look-up tables to recognize tissue characteristics and clamping positions and dynamically adjust the end effector 152200 and/or tissue clamped between the anvil 152202 and the staple cartridge 152206.
A plurality of secondary sensors 152260a-152260d is coupled to the second jaw member 152254. The plurality of secondary sensors 152260a-152260d may be formed integrally with the second jaw member 152254 and/or the staple cartridge 152256. For example, in one embodiment, the plurality of secondary sensors 152260a-152260d is disposed on an outer row of the staple cartridge 152256 (see
In some embodiments, the plurality of secondary sensors 152260a-152260d comprises dual purpose sensors and tissue stabilizing elements. The plurality of secondary sensors 152260a-152260d comprise electrodes and/or sensing geometries configured to create a stabilized tissue condition when the plurality of secondary sensors 152260a-152260d are engaged with a tissue section 152264, such as, for example, during a clamping operation. In some embodiments, one or more of the plurality of secondary sensors 152260a-152260d may be replaced with non-sensing tissue stabilizing elements. The secondary sensors 152260a-152260d create a stabilized tissue condition by controlling tissue flow, staple formation, and/or other tissue conditions during a clamping, stapling, and/or other treatment process.
In some embodiments, the plurality of sensors 152308a, 152308b comprise redundant sensors. The redundant sensors are configured to detect the same properties of the end effector 152300 and/or a tissue section located between the anvil 152302 and the staple cartridge 152306. The redundant sensors may comprise, for example, Hall effect sensors configured to detect the gap 152310 between the anvil 152302 and the staple cartridge 152306. The redundant sensors provide signals representative of one or more parameters allowing a processor, such as, for example, the primary processor, to evaluate the multiple inputs and determine the most reliable input. In some embodiments, the redundant sensors are used to reduce noise, false signals, and/or drift. Each of the redundant sensors may be measured in real-time during clamping, allowing time-based information to be analyzed and algorithms and/or look-up tables to recognize tissue characteristics and clamping positioning dynamically. The input of one or more of the redundant sensors may be adjusted and/or selected to identify the true tissue thickness and bite of a tissue section located between the anvil 152302 and the staple cartridge 152306.
In one embodiment, the sensor 152358 comprises a magnetic sensor configured to detect a magnetic field generated by an electromagnetic source 152360 coupled to the second jaw member 152354 and/or the staple cartridge 152356. The electromagnetic source 152360 generates a magnetic field detected by the sensor 152358. The strength of the detected magnetic field may correspond to, for example, the thickness and/or fullness of a bite of tissue located between the anvil 152352 and the staple cartridge 152356. In some embodiments, the electromagnetic source 152360 generates a signal at a known frequency, such as, for example, 1 MHz. In other embodiments, the signal generated by the electromagnetic source 152360 may be adjustable based on, for example, the type of staple cartridge 152356 installed in the second jaw member 152354, one or more additional sensor, an algorithm, and/or one or more parameters.
In one embodiment, a signal processor 152362 is coupled to the end effector 152350, such as, for example, the anvil 152352. The signal processor 152362 is configured to process the signal generated by the sensor 152358 to eliminate false signals and to boost the input from the sensor 152358. In some embodiments, the signal processor 152362 may be located separately from the end effector 152350, such as, for example, in the handle 150014 of the surgical instrument 150010. In some embodiments, the signal processor 152362 is formed integrally with and/or comprises an algorithm executed by a general processor, such as, for example, the primary processor. The signal processor 152362 is configured to process the signal from the sensor 152358 at a frequency substantially equal to the frequency of the signal generated by the electromagnetic source 152360. For example, in one embodiment, the electromagnetic source 152360 generates a signal at a frequency of 1 MHz. The signal is detected by the sensor 152358. The sensor 152358 generates a signal indicative of the detected magnetic field which is provided to the signal processor 152362. The signal is processed by the signal processor 152362 at a frequency of 1 MHz to eliminate false signals. The processed signal is provided to a processor, such as, for example, the primary processor. The primary processor correlates the received signal to one or more parameters of the end effector 152350, such as, for example, the gap 152364 between the anvil 152352 and the staple cartridge 152356.
The sensor 152408 can be operable to detect a property of the staple cartridge 152406 and thereby identify the staple cartridge 152406 type.
Alternately or additionally, the optical emitter and detector 152410, or another suitable sensor 152408, can interrogate and identify some other symbol or marking on the staple cartridge 152406. The symbol or marking can be any one of a barcode, a shape or character, a color-coded emblem, or any other suitable marking. The information read by the sensor 152408 can be communicated to a microcontroller in the surgical device 150010, such as for instance a microcontroller (e.g., microcontroller 461 (
Accordingly, as used herein, the term displacement member is used generically to refer to any movable member of a surgical instrument or system as described herein, such as a drive member, firing member, firing bar, cutting instrument, knife, and/or I-beam, or any element that can be displaced. Accordingly, the absolute positioning system 153100 can, in effect, track the displacement of the cutting instrument I-beam 153514 (
An electric motor 153120 can include a rotatable shaft 153116 that operably interfaces with a gear assembly 153114 that is mounted in meshing engagement with a set, or rack, of drive teeth on the displacement member 153111. A sensor element 153126 may be operably coupled to the gear assembly 153114 such that a single revolution of the sensor element 153126 corresponds to some linear longitudinal translation of the displacement member 153111. An arrangement of gearing and sensors 153118 can be connected to the linear actuator via a rack and pinion arrangement or a rotary actuator via a spur gear or other connection. A power source 153129 supplies power to the absolute positioning system 153100 and an output indicator 153128 may display the output of the absolute positioning system 153100.
A single revolution of the sensor element 153126 associated with the position sensor 153112 is equivalent to a longitudinal displacement d1 of the of the displacement member 153111, where d1 is the longitudinal distance that the displacement member 153111 moves from point “a” to point “b” after a single revolution of the sensor element 153126 coupled to the displacement member 153111. The sensor arrangement 153102 may be connected via a gear reduction that results in the position sensor 153112 completing one or more revolutions for the full stroke of the displacement member 153111. The position sensor 153112 may complete multiple revolutions for the full stroke of the displacement member 153111.
A series of switches 153122a-153122n, where n is an integer greater than one, may be employed alone or in combination with gear reduction to provide a unique position signal for more than one revolution of the position sensor 153112. The state of the switches 153122a-153122n are fed back to a controller 153110 that applies logic to determine a unique position signal corresponding to the longitudinal displacement d1+d2+ . . . dn of the displacement member 153111. The output 153124 of the position sensor 153112 is provided to the controller 153110. The position sensor 153112 of the sensor arrangement 153102 may comprise a magnetic sensor, an analog rotary sensor like a potentiometer, an array of analog Hall-effect elements, which output a unique combination of position signals or values. The controller 153110 may be contained within a master controller or may be contained within a tool mounting portion housing of a surgical instrument or system in accordance with the present disclosure.
The absolute positioning system 153100 provides an absolute position of the displacement member 153111 upon power up of the surgical instrument or system without retracting or advancing the displacement member 153111 to a reset (zero or home) position as may be required with conventional rotary encoders that merely count the number of steps forwards or backwards that the motor 153120 has taken to infer the position of a device actuator, drive bar, knife, and the like.
The controller 153110 may be programmed to perform various functions such as precise control over the speed and position of the knife and articulation systems. In one aspect, the controller 153110 includes a processor 153108 and a memory 153106. The electric motor 153120 may be a brushed DC motor with a gearbox and mechanical links to an articulation or knife system. In one aspect, a motor driver 153110 may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers may be readily substituted for use in the absolute positioning system 153100.
The controller 153110 may be programmed to provide precise control over the speed and position of the displacement member 153111 and articulation systems. The controller 153110 may be configured to compute a response in the software of the controller 153110. The computed response is compared to a measured response of the actual system to obtain an “observed” response, which is used for actual feedback decisions. The observed response is a favorable, tuned, value that balances the smooth, continuous nature of the simulated response with the measured response, which can detect outside influences on the system.
The absolute positioning system 153100 may comprise and/or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power source 153129 converts the signal from the feedback controller into a physical input to the system, in this case voltage. Other examples include pulse width modulation (PWM) of the voltage, current, and force. Other sensor(s) 153118 may be provided to measure physical parameters of the physical system in addition to position measured by the position sensor 153112. In a digital signal processing system, absolute positioning system 153100 is coupled to a digital data acquisition system where the output of the absolute positioning system 153100 will have finite resolution and sampling frequency. The absolute positioning system 153100 may comprise a compare and combine circuit to combine a computed response with a measured response using algorithms such as weighted average and theoretical control loop that drives the computed response towards the measured response. The computed response of the physical system takes into account properties like mass, inertial, viscous friction, inductance resistance, etc., to predict what the states and outputs of the physical system will be by knowing the input.
The motor driver 153110 may be an A3941 available from Allegro Microsystems, Inc. The A3941 driver 153110 is a full-bridge controller for use with external N-channel power metal oxide semiconductor field effect transistors (MOSFETs) specifically designed for inductive loads, such as brush DC motors. The driver 153110 comprises a unique charge pump regulator provides full (>10 V) gate drive for battery voltages down to 7 V and allows the A3941 to operate with a reduced gate drive, down to 5.5 V. A bootstrap capacitor may be employed to provide the above-battery supply voltage required for N-channel MOSFETs. An internal charge pump for the high-side drive allows DC (100% duty cycle) operation. The full bridge can be driven in fast or slow decay modes using diode or synchronous rectification. In the slow decay mode, current recirculation can be through the high-side or the lowside FETs. The power FETs are protected from shoot-through by resistor adjustable dead time. Integrated diagnostics provide indication of undervoltage, overtemperature, and power bridge faults, and can be configured to protect the power MOSFETs under most short circuit conditions. Other motor drivers may be readily substituted for use in the absolute positioning system 153100.
The Hall-effect elements 153228A, 153228B, 153228C, 153228D are located directly above the rotating magnet. The Hall-effect is a well-known effect and for expediency will not be described in detail herein, however, generally, the Hall-effect produces a voltage difference (the Hall voltage) across an electrical conductor transverse to an electric current in the conductor and a magnetic field perpendicular to the current. A Hall coefficient is defined as the ratio of the induced electric field to the product of the current density and the applied magnetic field. It is a characteristic of the material from which the conductor is made, since its value depends on the type, number, and properties of the charge carriers that constitute the current. In the AS5055 position sensor 153200, the Hall-effect elements 153228A, 153228B, 153228C, 153228D are capable producing a voltage signal that is indicative of the absolute position of the magnet in terms of the angle over a single revolution of the magnet. This value of the angle, which is unique position signal, is calculated by the CORDIC processor 153236 is stored onboard the AS5055 position sensor 153200 in a register or memory. The value of the angle that is indicative of the position of the magnet over one revolution is provided to the controller 153110 in a variety of techniques, e.g., upon power up or upon request by the controller 153110.
The AS5055 position sensor 153200 requires only a few external components to operate when connected to the controller 153110. Six wires are needed for a simple application using a single power supply: two wires for power and four wires 153240 for the SPI interface 153234 with the controller 153110. A seventh connection can be added in order to send an interrupt to the controller 153110 to inform that a new valid angle can be read. Upon power-up, the AS5055 position sensor 153200 performs a full power-up sequence including one angle measurement. The completion of this cycle is indicated as an INT output 153242, and the angle value is stored in an internal register. Once this output is set, the AS5055 position sensor 153200 suspends to sleep mode. The controller 153110 can respond to the INT request at the INT output 153242 by reading the angle value from the AS5055 position sensor 153200 over the SPI interface 153234. Once the angle value is read by the controller 153110, the INT output 153242 is cleared again. Sending a “read angle” command by the SPI interface 153234 by the controller 153110 to the position sensor 153200 also automatically powers up the chip and starts another angle measurement. As soon as the controller 153110 has completed reading of the angle value, the INT output 153242 is cleared and a new result is stored in the angle register. The completion of the angle measurement is again indicated by setting the INT output 153242 and a corresponding flag in the status register.
Due to the measurement principle of the AS5055 position sensor 153200, only a single angle measurement is performed in very short time (˜600 μs) after each power-up sequence. As soon as the measurement of one angle is completed, the AS5055 position sensor 153200 suspends to power-down state. An on-chip filtering of the angle value by digital averaging is not implemented, as this would require more than one angle measurement and, consequently, a longer power-up time that is not desired in low-power applications. The angle jitter can be reduced by averaging of several angle samples in the controller 153110. For example, an averaging of four samples reduces the jitter by 6 dB (50%).
An example I-beam 153514 firing stroke is illustrated by a chart 153529 aligned with the end effector 153502. Example tissue 153526 is also shown aligned with the end effector 153502. The firing member stroke may comprise a stroke begin position 153527 and a stroke end position 153528. During an I-beam 153514 firing stroke, the I-beam 153514 may be advanced distally from the stroke begin position 153527 to the stroke end position 153528. The I-beam 153514 is shown at one example location of a stroke begin position 153527. The I-beam 153514 firing member stroke chart 153529 illustrates five firing member stroke regions 153517, 153519, 153521, 153523, 153525. In a first firing stroke region 153517, the I-beam 153514 may begin to advance distally. In the first firing stroke region 153517, the I-beam 153514 may contact the wedge sled 153513 and begin to move it distally. While in the first region, however, the cutting edge 153509 may not contact tissue and the wedge sled 153513 may not contact a staple driver 153511. After static friction is overcome, the force to drive the I-beam 153514 in the first region 153517 may be substantially constant.
In the second firing member stroke region 153519, the cutting edge 153509 may begin to contact and cut tissue 153526. Also, the wedge sled 153513 may begin to contact staple drivers 153511 to drive staples 153505. Force to drive the I-beam 153514 may begin to ramp up. As shown, tissue encountered initially may be compressed and/or thinner because of the way that the anvil 153516 pivots relative to the staple cartridge 153518. In the third firing member stroke region 153521, the cutting edge 153509 may continuously contact and cut tissue 153526 and the wedge sled 153513 may repeatedly contact staple drivers 153511. Force to drive the I-beam 153514 may plateau in the third region 153521. By the fourth firing stroke region 153523, force to drive the I-beam 153514 may begin to decline. For example, tissue in the portion of the end effector 153502 corresponding to the fourth firing region 153523 may be less compressed than tissue closer to the pivot point of the anvil 153516, requiring less force to cut. Also, the cutting edge 153509 and wedge sled 153513 may reach the end of the tissue 153526 while in the fourth region 153523. When the I-beam 153514 reaches the fifth region 153525, the tissue 153526 may be completely severed. The wedge sled 153513 may contact one or more staple drivers 153511 at or near the end of the tissue. Force to advance the I-beam 153514 through the fifth region 153525 may be reduced and, in some examples, may be similar to the force to drive the I-beam 153514 in the first region 153517. At the conclusion of the firing member stroke, the I-beam 153514 may reach the stroke end position 153528. The positioning of firing member stroke regions 153517, 153519, 153521, 153523, 153525 in
As discussed above and with reference now to
Force acting on the I-beam 153514 may be determined using various techniques. The I-beam 153514 force may be determined by measuring the motor 153120 current, where the motor 153120 current is based on the load experienced by the I-beam 153514 as it advances distally. The I-beam 153514 force may be determined by positioning a strain gauge on the drive member, the firing member, I-beam 153514, the firing bar, and/or on a proximal end of the cutting edge 153509. The I-beam 153514 force may be determined by monitoring the actual position of the I-beam 153514 moving at an expected velocity based on the current set velocity of the motor 153120 after a predetermined elapsed period T1 and comparing the actual position of the I-beam 153514 relative to the expected position of the I-beam 153514 based on the current set velocity of the motor 153120 at the end of the period T1. Thus, if the actual position of the I-beam 153514 is less than the expected position of the I-beam 153514, the force on the I-beam 153514 is greater than a nominal force. Conversely, if the actual position of the I-beam 153514 is greater than the expected position of the I-beam 153514, the force on the I-beam 153514 is less than the nominal force. The difference between the actual and expected positions of the I-beam 153514 is proportional to the deviation of the force on the I-beam 153514 from the nominal force.
Prior to turning to a description of closed loop control techniques of the closure tube and firing member, the description turns briefly to
The first and second closure force plots 153606, 153608 indicate that the closure force in the end effector 153502 increases during an initial clamping time period ending at a time (t1). The closure force reaches a maximum force (F1, F3) at the time (t1). The initial clamping time period can be about one second, for example. A waiting period can be applied prior to initiating a firing stroke. The waiting period allows fluid egress from tissue compressed by the end effector 153502, which reduces the thickness of the compressed tissue yielding a smaller gap between the anvil 153516 and the staple cartridge 153518 and a reduced closure force at the end of the waiting period. With reference to the first closure force plot 153606, there is a nominal drop in closure force 153612 from F1 to F2 during the waiting period between t1 to t4. Similarly, with reference to the second closure force plot 153608, the closure force 153618 drops nominally from F3 to F4 during the waiting period between t1 to t4. In some examples, a waiting period (t1 to t4) selected from a range of about 10 seconds to about 20 seconds is typically employed. In the example first and second closure force plots 153606, 153608, a period of time of about 15 seconds is employed. The waiting period is followed by the firing stroke, which typically lasts a period of time selected from a range of about 3 seconds, for example, to about 5 seconds, for example. The closure force decreases as the I-beam 153514 is advanced relative to the end effector through the firing stroke. As indicated by the closure force 153614, 153620 of the first and second closure force plots 153606, 153608, respectively, the closure force 153614, 153620 exerted on the closure tube drops precipitously from about time t4 to about time t5. Time t4 represents the moment where the I-beam 153514 couples into the anvil 153516 and begins to take over the closing load. Accordingly, the closure force decreases as the firing force increases as shown by the first and second firing force plots 153622, 153624.
As previously described, the closure tube force drops precipitously from time t4 to about time t5, which represents the moment the I-beam 153514 couples into the anvil 153516 and begins to take load and the closure force decreases as the firing force increases as shown by the first and second firing force plots 153622, 153624. The I-beam 153514 is advanced from the stroke begin position at time t4 to the stroke end positions between t8 and t9 for the firing force plot 153624 for thin tissue and at t13 for the firing force plot 153622 for thick tissue. As the I-beam 153514 is advanced distally during the firing stroke, the closure assembly surrenders control of the staple cartridge 153518 and the anvil 153516 to the firing assembly, which causes the firing force to increase and the closure force to decrease.
In the thick tissue firing force plot 153622, during the firing period (FIRE) the plot 153622 is divided into three distinct segments. A first segment 153628 indicates the firing force as it increases from 0 at t4 to a peak force F1′ just prior to t5. The first segment 153628 is the firing force during the initial phase of the firing stroke where the I-beam 153514 advances distally from the top of the closure ramp until the I-beam 153514 contacts tissue. A second segment 153630 indicates the firing force during a second phase of the firing stroke where the I-beam 153514 is advancing distally deploying staples and cutting the tissue. During the second phase of the firing stroke the firing force drops from F1′ to F2′ at about t12. A third segment 153632 indicates the firing force during the third and final phase of the firing stroke where the I-beam 153514 leaves the tissue and advances to the end of stroke in a tissue free zone. During the third phase of the firing stroke the firing force drops to from F2′ to zero (0) at about t13 where the I-beam 153514 reaches the end of stroke. In summary, during the firing stroke, the firing force rises dramatically as the I-beam 153514 enters a tissue zone, decrease steadily in the tissue zone during the stapling and cutting operation, and drops dramatically as the I-beam 153514 exits the tissue zone and enters a tissue free zone at the end of stroke.
The thin tissue firing force plot 153624 follows a similar pattern as the thick tissue firing force plot 153622. Thus, during the first phase of the firing stroke the firing force 153634 increases dramatically from 0 to F3′ at about t5. During the second phase of the firing stroke, the firing force 153636 drops steadily from F3′ to F4′ at about t8. During the final phase of the firing stroke the firing force 153638 drops dramatically from F′4 to 0 between t8 and t9.
To overcome the precipitous drop in closure force from time t4 to about time t5, which represents the moment the I-beam 153514 couples into the anvil 153516 and begins to take load and the closure force decreases as the firing force increases, as shown by the first and second firing force plots 153622, 153624, the closure tube may be advanced distally while the firing member such as the I-beam 153514 is advancing distally. The closure tube is represented as a transmission element that applies a closure force to the anvil 153516. As described herein, a control circuit applies motor set points to the motor control which applies a motor control signal to the motor to drive the transmission element and advance the closure tube distally to apply a closing force to the anvil 153516. A torque sensor coupled to an output shaft of the motor can be used to measure the force applied to the closure tube. In other aspects, the closure force can be measured with a strain gauge, load cell, or other suitable force sensor.
In the context of controlling the displacement of the closure tube, the control system 153950 may be configured such that the primary set point SP1 is a desired closure force value and the primary controller 153952 is configured to receive the closure force from the torque sensor coupled to the output of the closure motor and determine a set point SP2 motor velocity for the closure motor. In other aspects, the closure force may be measured with strain gauges, load cells, or other suitable force sensors. The closure motor velocity set point SP2 is compared to the actual velocity of the closure tube, which is determined by the secondary controller 153955. The actual velocity of the closure tube may be measured by comparing the displacement of the closure tube with the position sensor and measuring elapsed time with the timer/counter. Other techniques, such as linear or rotary encoders may be employed to measure displacement of the closure tube. The output 153968 of the secondary process 153960 is the actual velocity of the closure tube. This closure tube velocity output 153968 is provided to the primary process 153958 which determines the force acting on the closure tube and is fed back to the adder 153962, which subtracts the measured closure force from the primary set point SP1. The primary set point SP1 may be an upper threshold or a lower threshold. Based on the output of the adder 153962, the primary controller 153952 controls the velocity and direction of the closure tube motor as described herein. The secondary controller 153955 controls the velocity of the closure motor based on the actual velocity of closure tube measured by the secondary process 153960 and the secondary set point SP2, which is based on a comparison of the actual firing force and the firing force upper and lower thresholds.
In accordance with the PID algorithm, the “P” element 153974 accounts for present values of the error. For example, if the error is large and positive, the control output will also be large and positive. In accordance with the present disclosure, the error term e(t) is the different between the desired closure force and the measured closure force of the closure tube. The “I” element 153976 accounts for past values of the error. For example, if the current output is not sufficiently strong, the integral of the error will accumulate over time, and the controller will respond by applying a stronger action. The “D” element 153978 accounts for possible future trends of the error, based on its current rate of change. For example, continuing the P example above, when the large positive control output succeeds in bringing the error closer to zero, it also puts the process on a path to large negative error in the near future. In this case, the derivative turns negative and the D module reduces the strength of the action to prevent this overshoot.
It will be appreciated that other variables and set points may be monitored and controlled in accordance with the feedback control systems 153950, 153970. For example, the adaptive closure member velocity control algorithm described herein may measure at least two of the following parameters: firing member stroke location, firing member load, displacement of cutting element, velocity of cutting element, closure tube stroke location, closure tube load, among others.
With reference now also to
In one aspect, the threshold closure force SP1 comprises an upper threshold and a lower threshold. The set point velocity SP2 is configured to advance the closure member distally when the actual closure force is less than the lower threshold and the set point velocity is configured to retract the closure member proximally when the actual closure force is greater than the lower threshold. In one aspect, the set point velocity is configured to hold the closure member in place when the actual closure force is between the upper and lower thresholds.
In one aspect, the control system further comprises a force sensor (e.g., any of sensors 472, 474, 476 (
In one aspect, the control system comprises a first motor configured to couple to the closure member and the control circuit is configured to advance the closure member during at least a portion of a firing stroke.
The functions or processes 153990 described herein may be executed by any of the processing circuits described herein. Aspects of the motorized surgical instrument may be practiced without the specific details disclosed herein. Some aspects have been shown as block diagrams rather than detail.
Parts of this disclosure may be presented in terms of instructions that operate on data stored in a computer memory. An algorithm refers to a self-consistent sequence of steps leading to a desired result, where a “step” refers to a manipulation of physical quantities which may take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. These signals may be referred to as bits, values, elements, symbols, characters, terms, numbers. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities.
Generally, aspects described herein which can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or any combination thereof can be viewed as being composed of various types of “electrical circuitry.” Consequently, “electrical circuitry” includes electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application specific integrated circuit, electrical circuitry forming a general purpose computing device configured by a computer program (e.g., a general purpose computer or processor configured by a computer program which at least partially carries out processes and/or devices described herein, electrical circuitry forming a memory device (e.g., forms of random access memory), and/or electrical circuitry forming a communications device (e.g., a modem, communications switch, or optical-electrical equipment). These aspects may be implemented in analog or digital form, or combinations thereof.
The foregoing description has set forth aspects of devices and/or processes via the use of block diagrams, flowcharts, and/or examples, which may contain one or more functions and/or operation. Each function and/or operation within such block diagrams, flowcharts, or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. In one aspect, several portions of the subject matter described herein may be implemented via Application Specific Integrated Circuits (ASICs), Field Programmable Gate Arrays (FPGAs), digital signal processors (DSPs), Programmable Logic Devices (PLDs), circuits, registers and/or software components, e.g., programs, subroutines, logic and/or combinations of hardware and software components. Logic gates, or other integrated formats. Some aspects disclosed herein, in whole or in part, can be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and or firmware would be well within the skill of one of skill in the art in light of this disclosure.
The mechanisms of the disclosed subject matter are capable of being distributed as a program product in a variety of forms, and that an illustrative aspect of the subject matter described herein applies regardless of the particular type of signal bearing medium used to actually carry out the distribution. Examples of a signal bearing medium include the following: a recordable type medium such as a floppy disk, a hard disk drive, a Compact Disc (CD), a Digital Video Disk (DVD), a digital tape, a computer memory, etc.; and a transmission type medium such as a digital and/or an analog communication medium (e.g., a fiber optic cable, a waveguide, a wired communications link, a wireless communication link (e.g., transmitter, receiver, transmission logic, reception logic, etc.).
The foregoing description of these aspects has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. These aspects were chosen and described in order to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize the aspects and with modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope.
Situational awareness is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from databases and/or instruments. The information can include the type of procedure being undertaken, the type of tissue being operated on, or the body cavity that is the subject of the procedure. With the contextual information related to the surgical procedure, the surgical system can, for example, improve the manner in which it controls the modular devices (e.g. a robotic arm and/or robotic surgical tool) that are connected to it and provide contextualized information or suggestions to the surgeon during the course of the surgical procedure.
Referring now to
The situationally aware surgical hub 106, 206 receives data from the data sources throughout the course of the surgical procedure, including data generated each time medical personnel utilize a modular device that is paired with the surgical hub 106, 206. The surgical hub 106, 206 can receive this data from the paired modular devices and other data sources and continually derive inferences (i.e., contextual information) about the ongoing procedure as new data is received, such as which step of the procedure is being performed at any given time. The situational awareness system of the surgical hub 106, 206 is able to, for example, record data pertaining to the procedure for generating reports, verify the steps being taken by the medical personnel, provide data or prompts (e.g., via a display screen) that may be pertinent for the particular procedural step, adjust modular devices based on the context (e.g., activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and take any other such action described above.
As the first step S202 in this illustrative procedure, the hospital staff members retrieve the patient's EMR from the hospital's EMR database. Based on select patient data in the EMR, the surgical hub 106, 206 determines that the procedure to be performed is a thoracic procedure.
Second step S204, the staff members scan the incoming medical supplies for the procedure. The surgical hub 106, 206 cross-references the scanned supplies with a list of supplies that are utilized in various types of procedures and confirms that the mix of supplies corresponds to a thoracic procedure. Further, the surgical hub 106, 206 is also able to determine that the procedure is not a wedge procedure (because the incoming supplies either lack certain supplies that are necessary for a thoracic wedge procedure or do not otherwise correspond to a thoracic wedge procedure).
Third step S206, the medical personnel scan the patient band via a scanner that is communicably connected to the surgical hub 106, 206. The surgical hub 106, 206 can then confirm the patient's identity based on the scanned data.
Fourth step S208, the medical staff turns on the auxiliary equipment. The auxiliary equipment being utilized can vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, insufflator, and medical imaging device. When activated, the auxiliary equipment that are modular devices can automatically pair with the surgical hub 106, 206 that is located within a particular vicinity of the modular devices as part of their initialization process. The surgical hub 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices that pair with it during this pre-operative or initialization phase. In this particular example, the surgical hub 106, 206 determines that the surgical procedure is a VATS procedure based on this particular combination of paired modular devices. Based on the combination of the data from the patient's EMR, the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the hub, the surgical hub 106, 206 can generally infer the specific procedure that the surgical team will be performing. Once the surgical hub 106, 206 knows what specific procedure is being performed, the surgical hub 106, 206 can then retrieve the steps of that procedure from a memory or from the cloud and then cross-reference the data it subsequently receives from the connected data sources (e.g., modular devices and patient monitoring devices) to infer what step of the surgical procedure the surgical team is performing.
Fifth step S210, the staff members attach the EKG electrodes and other patient monitoring devices to the patient. The EKG electrodes and other patient monitoring devices are able to pair with the surgical hub 106, 206. As the surgical hub 106, 206 begins receiving data from the patient monitoring devices, the surgical hub 106, 206 thus confirms that the patient is in the operating theater.
Sixth step S212, the medical personnel induce anesthesia in the patient. The surgical hub 106, 206 can infer that the patient is under anesthesia based on data from the modular devices and/or patient monitoring devices, including EKG data, blood pressure data, ventilator data, or combinations thereof, for example. Upon completion of the sixth step S212, the pre-operative portion of the lung segmentectomy procedure is completed and the operative portion begins.
Seventh step S214, the patient's lung that is being operated on is collapsed (while ventilation is switched to the contralateral lung). The surgical hub 106, 206 can infer from the ventilator data that the patient's lung has been collapsed, for example. The surgical hub 106, 206 can infer that the operative portion of the procedure has commenced as it can compare the detection of the patient's lung collapsing to the expected steps of the procedure (which can be accessed or retrieved previously) and thereby determine that collapsing the lung is the first operative step in this particular procedure.
Eighth step S216, the medical imaging device (e.g., a scope) is inserted and video from the medical imaging device is initiated. The surgical hub 106, 206 receives the medical imaging device data (i.e., video or image data) through its connection to the medical imaging device. Upon receipt of the medical imaging device data, the surgical hub 106, 206 can determine that the laparoscopic portion of the surgical procedure has commenced. Further, the surgical hub 106, 206 can determine that the particular procedure being performed is a segmentectomy, as opposed to a lobectomy (note that a wedge procedure has already been discounted by the surgical hub 106, 206 based on data received at the second step S204 of the procedure). The data from the medical imaging device 124 (
Ninth step S218, the surgical team begins the dissection step of the procedure. The surgical hub 106, 206 can infer that the surgeon is in the process of dissecting to mobilize the patient's lung because it receives data from the RF or ultrasonic generator indicating that an energy instrument is being fired. The surgical hub 106, 206 can cross-reference the received data with the retrieved steps of the surgical procedure to determine that an energy instrument being fired at this point in the process (i.e., after the completion of the previously discussed steps of the procedure) corresponds to the dissection step. In certain instances, the energy instrument can be an energy tool mounted to a robotic arm of a robotic surgical system.
Tenth step S220, the surgical team proceeds to the ligation step of the procedure. The surgical hub 106, 206 can infer that the surgeon is ligating arteries and veins because it receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similarly to the prior step, the surgical hub 106, 206 can derive this inference by cross-referencing the receipt of data from the surgical stapling and cutting instrument with the retrieved steps in the process. In certain instances, the surgical instrument can be a surgical tool mounted to a robotic arm of a robotic surgical system.
Eleventh step S222, the segmentectomy portion of the procedure is performed. The surgical hub 106, 206 can infer that the surgeon is transecting the parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond to the size or type of staple being fired by the instrument, for example. As different types of staples are utilized for different types of tissues, the cartridge data can thus indicate the type of tissue being stapled and/or transected. In this case, the type of staple being fired is utilized for parenchyma (or other similar tissue types), which allows the surgical hub 106, 206 to infer that the segmentectomy portion of the procedure is being performed.
Twelfth step S224, the node dissection step is then performed. The surgical hub 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator indicating that an RF or ultrasonic instrument is being fired. For this particular procedure, an RF or ultrasonic instrument being utilized after parenchyma was transected corresponds to the node dissection step, which allows the surgical hub 106, 206 to make this inference. It should be noted that surgeons regularly switch back and forth between surgical stapling/cutting instruments and surgical energy (i.e., RF or ultrasonic) instruments depending upon the particular step in the procedure because different instruments are better adapted for particular tasks. Therefore, the particular sequence in which the stapling/cutting instruments and surgical energy instruments are used can indicate what step of the procedure the surgeon is performing. Moreover, in certain instances, robotic tools can be utilized for one or more steps in a surgical procedure and/or handheld surgical instruments can be utilized for one or more steps in the surgical procedure. The surgeon(s) can alternate between robotic tools and handheld surgical instruments and/or can use the devices concurrently, for example. Upon completion of the twelfth step S224, the incisions are closed up and the post-operative portion of the procedure begins.
Thirteenth step S226, the patient's anesthesia is reversed. The surgical hub 106, 206 can infer that the patient is emerging from the anesthesia based on the ventilator data (i.e., the patient's breathing rate begins increasing), for example.
Lastly, the fourteenth step S228 is that the medical personnel remove the various patient monitoring devices from the patient. The surgical hub 106, 206 can thus infer that the patient is being transferred to a recovery room when the hub loses EKG, BP, and other data from the patient monitoring devices. As can be seen from the description of this illustrative procedure, the surgical hub 106, 206 can determine or infer when each step of a given surgical procedure is taking place according to data received from the various data sources that are communicably coupled to the surgical hub 106, 206.
Situational awareness is further described in U.S. Provisional Patent Application Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, which is incorporated by reference herein in its entirety. In certain instances, operation of a robotic surgical system, including the various robotic surgical systems disclosed herein, for example, can be controlled by the hub 106, 206 based on its situational awareness and/or feedback from the components thereof and/or based on information from the cloud 104.
Various aspects of the present disclosure are directed to improved safety systems capable of adapting, controlling, and/or tuning internal drive operations of a surgical instrument in response to tissue parameters detected via one or more than one sensor of the surgical instrument. In accordance with at least one aspect, a force detected, via one or more than one sensor, at the jaws of an end effector may be of a magnitude that prohibits one or more than one subsequent/further functionality of the end effector from being performed. According to another aspect, a metallic object may be detected, via one or more than one sensor, as within the jaws of the end effector that prohibits one or more than one subsequent/further functionality of the end effector from being performed.
Referring to
Also in
Further, in such an aspect, the surgical instrument 23102 may further comprise a shaft assembly 23120 including a sensor 23124 configured to detect a parameter associated with a function (e.g., rotation, articulation, etc.) of the shaft assembly 23120 and to transmit the detected parameter to the control circuit 23142 of the surgical hub 23140. Notably, it should be appreciated that a sensor, as referenced herein and in other disclosed aspects, may comprise a plurality of sensors configured to detect a plurality of parameters associated with a plurality of end effector assembly and/or shaft assembly functions. As such, further, in such an aspect, the surgical hub control circuit 23142 may be configured to receive detected parameters (e.g., sensor data) from such sensors 23134 and/or 23124 throughout the course of the surgical procedure.
A detected parameter can be received each time an associated end effector assembly 23130 function (e.g., dissection, clamping, coagulation, cutting, stapling, etc.) and/or an associated shaft assembly 23120 function (e.g., rotating, articulating, etc.) is performed. The surgical hub control circuit 23142 may be further configured to receive data from an internal database (e.g., a surgical hub database 23149) and/or an external database (e.g., from a cloud database 23150) throughout the course of the surgical procedure. According to various aspects, the data received from the internal and/or external databases may comprise procedural data (e.g., steps to perform the surgical procedure) and/or historical data (e.g., data indicating expected parameters based on historical data associated with the surgical procedure).
In various aspects, the procedural data may comprise current/recognized standard-of-care procedures for the surgical procedure and the historical data may comprise preferred/ideal parameters and/or preferred/ideal parameter ranges based on historical data associated with the surgical procedure (e.g., system-defined constraints). Based on the received data (e.g., sensor data, internal and/or external data, etc.), the surgical hub control circuit 23142 may be configured to continually derive inferences (e.g., contextual information) about the ongoing surgical procedure. Namely, the situationally aware surgical hub may be configured to, for example, record data pertaining to the surgical procedure for generating reports, verify the steps being taken by the surgeon to perform the surgical procedure, provide data or prompts (e.g., via a user interface associated with the surgical hub and/or the surgical instrument, e.g., 23148, 23158, 23118, 23128, and/or 23138) that may be pertinent for a particular procedural step, control a surgical instrument function, etc. According to various aspects, the situationally aware surgical hub 23140 may (e.g., after an initial surgical function of the end effector assembly 23130 or the shaft assembly 23120 is performed) infer a next surgical function to be performed based on procedural data received from an internal database 23149 and/or an external database 23150.
Further, in such an aspect, the situationally aware surgical hub 23140 may evaluate detected parameters (e.g., received from sensors 23134 and/or 23124 in response to the initial surgical function) based on historical data received from the internal database 23149 and/or the external database 23150 (e.g., preferred/ideal parameters). Here, if the detected parameters do not exceed the preferred/ideal parameters and/or are within respective preferred/ideal parameter ranges, the situationally aware surgical hub 23140 may permit the next surgical function to be performed and/or not prevent/control the next surgical function from being performed. Alternatively, if the detected parameters do exceed the preferred/ideal parameters and/or are not within respective preferred/ideal parameter ranges, the situationally aware surgical hub 23140 may proactively prevent the next surgical function from being performed.
According to another aspect of the present disclosure, the situationally aware surgical hub 23140 may receive a communication (e.g., from a component, e.g., 23130 and/or 23120, of the surgical instrument 23102) that a particular surgical function is being attempted/requested/actuated. In such an aspect, the situationally aware surgical hub 23140 may compare that particular surgical function to an inferred next surgical function to ensure that current/recognized standard-of-care procedures are being adhered to. If so, the situationally aware surgical hub 23140 may then evaluate detected parameters (e.g., as described) before permitting that particular surgical function to proceed (as described). If not, the situationally aware surgical hub 23140 may prevent that particular surgical function from being performed or prevent that particular surgical function from being performed until an override is received (e.g., via a user interface 23, 158, 23148, 23138, 23128 and/or 23118, see, e.g.,
Referring again to
For example, in such an aspect, the detected parameter may be transmitted to a control circuit 23132 of the end effector assembly 23130. Here, the end effector assembly control circuit 23132 may be configured to receive detected parameters (e.g., sensor data) from the sensor 23134 throughout the course of the surgical procedure. A detected parameter can be received each time an associated end effector assembly 23130 function (e.g., dissection, clamping, coagulation, cutting, stapling, etc.) is performed.
The end effector assembly 23130 may be further configured to receive data from an internal database (e.g., end effector memory 23136) and/or an external database (e.g., from a cloud database 23150 via a surgical hub 23140, from a surgical hub database 23149, etc.) throughout the course of the surgical procedure. According to various aspects, the data received from the internal and/or external databases may comprise staple cartridge data (e.g., sizes and/or types of staples associated with a staple cartridge positioned in the end effector assembly) and/or historical data (e.g., data indicating expected tissues and/or types of tissues to be stapled with those sizes and/or types of staples based on historical data). In various aspects, the received data may comprise preferred/ideal parameters and/or preferred/ideal parameter ranges associated with those sizes and/or types of staples or those expected tissues and/or tissue types, based on historical data (e.g., system-defined constraints). Based on the received data (e.g., sensor data, internal and/or external data, etc.), the end effector control circuit 23132 may be configured to continually derive inferences (e.g., contextual information) about the ongoing surgical procedure. Notably, according to an alternative aspect, the sensor 23134 of the end effector assembly 23130 may transmit the detected parameter to a control circuit (e.g., 23112 and/or 23122) associated with another surgical instrument 23102 component, for example, the handle assembly 23110 and/or the shaft assembly 23120. In such an aspect, that other surgical instrument component control circuit (e.g., 23112 and/or 23122) may be similarly configured to perform the various aspects of the end effector control circuit 23132 as described above. Furthermore, according to various aspects, the shaft assembly 23120 of the surgical instrument 23102 may include a sensor 23124 configured to detect a parameter associated with a function (e.g., rotation, articulation, etc.) of the shaft assembly 23120 and to transmit the detected parameter to a control circuit (e.g., 23112) similarly configured to perform the various aspects of the end effector control circuit 23132 as described above. In end, the situationally aware surgical instrument 23102 may be configured to, for example, alert its user of a discrepancy (e.g., via a user interface 23138 of the end effector assembly 23130, via a user interface (e.g., 23128 and/or 23118) of another surgical instrument 23102 component, for example, the shaft assembly 23120 and/or the handle assembly 23110, and/or via a user interface 23148 and/or 23158 associated with a surgical hub 23140 coupled to the surgical instrument 23102). For example, the discrepancy may include that a detected parameter exceeds a preferred/ideal parameter and/or a preferred/ideal parameter range associated with those sizes and/or types of staples or those expected tissues and/or tissue types. As a further example, the situationally aware surgical instrument 23102 may be configured to control a surgical instrument 23102 function based on the discrepancy. In accordance with at least one aspect, the situationally aware surgical instrument 23102 may prevent a surgical function based on a discrepancy.
Situationally Aware Functionality Control
As highlighted herein, various aspects of the present disclosure pertain to a surgical instrument performing a function (e.g., clamping), detecting a parameter associated with that function, using situational awareness aspects to assess, via a control circuit, whether that detected parameter is below or exceeds a predefined parameter (e.g., considered ideal/preferred) or is below or exceeds a predefined range (e.g., considered normal) for that parameter, and performing an action (i.e., stop a function(s), alert the user, inform the user of possible causes, etc.) in response to the detected parameter being outside the predefined parameter and/or predefined parameter/range. For example,
According to various aspects of the present disclosure, a force detected (e.g., via one or more than one sensor) at the jaws of an end effector assembly may be of a magnitude that prohibits one or more than one subsequent/further functionality of the end effector assembly from being performed. For example, referring back to
In one aspect, referring back to
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According to yet another aspect of the present disclosure, referring to
Short Detection and Functionality Control
According to various other aspects of the present disclosure, the functionality of a surgical instrument may be controlled based on one or more than one sensor configured to detect a short. Namely, if a metallic object is detected within the jaws, at least one surgical instrument function/actuation (e.g., cutting, coagulation, etc.) may me prevented/prohibited. For example,
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According to one aspect (e.g., bipolar mode), the first jaw may comprise an anvil and the second jaw may comprise an elongated channel configured to receive a staple cartridge, such as is depicted in
Referring again to
In such aspects, if continuity is detected, a conductive object (e.g., a clip, a staple, a staple line, metal element, etc.) may be present/exposed in the tissue grasped between the jaws. Notably, such a conductive object may be from the current surgical procedure and/or a previous surgical procedure. In such an aspect, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128, and/or 23118 and/or a user interface associated with a surgical hub 23148 and/or 23158) regarding the detection of the conductive object. For example, the alert may suggest that the surgeon reposition the end effector assembly 23130 such that the electrodes are not in contact with any conductive object and/or remove the conductive object causing the short. According to various aspects, the control circuit may be further configured to receive an override command (e.g., via the user interface, see, e.g.,
According to one aspect, the control circuit (23112, 23122, 23132, and/or 23142) may be configured to check for continuity to avoid transecting clips. In such an aspect, after a short being detected, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128, and/or 23118 and/or a user interface associated with a surgical hub 23148 and/or 23158) regarding the detection of a conductive object between the jaws. In one aspect, the surgeon may adjust the sensitivity of the control circuit via a user interface (e.g., an interactive user interface element on the surgical instrument, the surgical hub, a generator, etc.). In such an aspect, based on the adjustment, the control circuit may be configured to prevent firing if a conductive object is detected between the jaws.
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Various aspects of the subject matter described herein under the heading “SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING” are set out in the following examples:
A surgical system comprises a control circuit and a surgical instrument. The surgical instrument comprises a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to a distal end of the shaft assembly. The end effector assembly comprises a first jaw, a second jaw pivotably coupled to the first jaw, and a sensor. The sensor is configured to detect a parameter associated with a function of the end effector and transmit the detected parameter to the control circuit. The control circuit is configured to analyze the detected parameter based on a system-defined constraint and prevent at least one function of the surgical instrument based on a result of the analysis. The surgical system further comprises a user interface configured to provide a current status regarding at least one prevented function of the surgical instrument.
The surgical system of Example 1, wherein the system-defined constraint comprises at least one of a predefined parameter or a predefined parameter range based on historical data associated with a surgical procedure being performed by the surgical system.
The surgical system of Example 1 or 2, wherein the current status comprises a first message that the at least one function of the surgical instrument is prevented and a second message indicating a reason why the at least one function of the surgical instrument is prevented.
The surgical system of Example 1, 2, or 3, wherein the user interface comprises a user-interface element selectable to override the control circuit to permit the at least one function of the surgical instrument.
The surgical system of Example 1, 2, 3, or 4, wherein the sensor comprises a force sensor coupled to the end effector, wherein the detected parameter comprises a force applied to at least one of the first jaw or the second jaw of the end effector, and wherein the at least one function prevented via the control circuit comprises one or more than one of preventing use of an attached shaft, preventing a firing cycle from commencing, preventing articulation of the end effector, preventing shaft rotation, or preventing one or more than one of the first jaw or the second jaw from opening.
The surgical system of Example 1, 2, 3, 4, or 5, wherein the function of the end effector associated with the detected parameter comprises a clamping function, and wherein the at least one function of the surgical instrument prevented via the control circuit comprises one or more than one of a dissect function, a coagulation function, a staple function, or a cut function.
The surgical system of Example 1, 2, 3, 4, 5, or 6, further comprising a surgical hub communicatively coupled to the surgical instrument, wherein the surgical hub comprises the control circuit.
The surgical system of Example 7, wherein one of the handle assembly or the surgical hub comprises the user interface.
The surgical system of Example 1, 2, 3, 4, 5, 6, 7, or 8, wherein one of the handle assembly, the shaft assembly, or the end effector assembly of the surgical instrument comprises the control circuit.
The surgical system of Example 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the shaft assembly comprises a sensor configured to detect a shaft parameter associated with a function of the shaft and transmit the detected shaft parameter to the control circuit. The control circuit is further configured to prevent the at least one function of the surgical instrument further based on the detected shaft parameter.
A surgical system comprises a surgical hub and a surgical instrument communicatively coupled to the surgical hub. The surgical instrument comprises a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to a distal end of the shaft assembly. The end effector assembly comprises a first jaw, a second jaw pivotably coupled to the first jaw, and a sensor. The sensor is configured to detect a parameter associated with a function of the end effector and transmit the detected parameter to the surgical hub. The surgical hub comprises a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to analyze the detected parameter based on a system-defined constraint and prevent at least one function of the surgical instrument based on a result of the analysis. The surgical system further comprises a user interface configured to provide a current status regarding at least one prevented function of the surgical instrument.
The surgical system of Example 11, wherein the system-defined constraint comprises at least one of a predefined parameter or a predefined parameter range based on historical data associated with a surgical procedure being performed by the surgical system.
The surgical system of Example 11 or 12, wherein the current status comprises a first message that the at least one function of the surgical instrument is prevented and a second message indicating a reason why the at least one function of the surgical instrument is prevented.
The surgical system of Example 11, 12, or 13, wherein the user interface comprises a user-interface element selectable to override the surgical hub to permit the at least one function of the surgical instrument.
The surgical system of Example 11, 12, 13, or 14, wherein the sensor comprises a force sensor coupled to the end effector, wherein the detected parameter comprises a force applied to at least one of the first jaw or the second jaw of the end effector, and wherein the at least one function prevented via the surgical hub comprises one or more than one of preventing use of an attached shaft, preventing a firing cycle from commencing, preventing articulation of the end effector, preventing shaft rotation, or preventing one or more than one of the first jaw or the second jaw from opening.
The surgical system of Example 11, 12, 13, 14, or 15, wherein the function of the end effector associated with the detected parameter comprises a clamping function, and wherein the at least one function of the surgical instrument prevented via the surgical hub comprises one or more than one of a dissect function, a coagulation function, a staple function, or a cut function.
The surgical system of Example 11, 12, 13, 14, 15, or 16, wherein at least one of the handle assembly or the surgical hub comprises the user interface.
The surgical system of Example 11, 12, 13, 14, 15, 16, or 17, wherein the shaft assembly comprises a sensor configured to detect a shaft parameter associated with a function of the shaft and transmit the detected shaft parameter to the surgical hub. The memory further stores instructions executable by the processor to prevent the at least one function of the surgical instrument further based on the detected shaft parameter.
A non-transitory computer readable medium stores computer readable instructions which, when executed, causes a machine to analyze a detected parameter, associated with a function of an end effector of a surgical system, based on a system-defined constraint, the surgical system including a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to a distal end of the shaft assembly. The end effector assembly comprises a first jaw, a second jaw pivotably coupled to the first jaw, and a sensor configured to detect the detected parameter and transmit the detected parameter to the machine. The instructions, when executed, further cause the machine to prevent at least one function of the surgical system based on a result of the analysis, and generate a user interface. The user interface provides a current status regarding at least one prevented function of the surgical system.
The non-transitory computer readable medium of Example 19 further comprises instructions that, when executed, further cause the machine to generate an override element on the user interface. The override element is selectable to permit the at least one function of the surgical system.
Safety Systems for Assessing Operational Parameters
Various aspects of the present disclosure are directed to improved safety systems capable of adapting, controlling, and/or tuning internal drive operations of a surgical instrument in response to tissue parameters detected via one or more than one sensors of the surgical instrument. More specifically, various aspects are directed to sensing and indicating an appropriateness of current device parameters to sensed tissue parameters.
For example, sensed tissue parameters may include a type of the tissue, a thickness of the tissue, a stiffness of the tissue, a position of the tissue on a patient's anatomy, vascularization of the tissue, etc., and current device parameters may include cartridge color, cartridge type, adjuncts, clamp load, gap, firing rate, etc. As such, according to aspects of the present disclosure, physiologic sensing may indicate an inappropriate use of a device or a component thereof and/or an inappropriate positioning of the device.
In one example, an inappropriate use of a surgical instrument or a component thereof and/or an improper positioning of the surgical instrument may be determined, via an associated control circuit, based on physiologic sensing detected via one or more than one sensor at the jaws of the end effector. In such an example, after the determined inappropriate use and/or the determined improper positioning, the associated control circuit may prevent one or more than one functionality (e.g., stapling) of the end effector from being performed. Further, in such an example, the associated control circuit may permit the one or more than one functionality of the end effector if the associated control circuit determines that the surgical instrument or the component thereof and/or the positioning of the surgical instrument has been rectified (e.g., improper staple cartridge replaced, surgical instrument repositioned, etc.) or an override has been received (e.g., via a user interface on the surgical instrument, on a surgical hub coupled to the surgical instrument, in the surgical theater, etc.).
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According to one aspect, a situationally aware surgical hub (e.g., 24240) is paired (e.g., wirelessly) with a surgical instrument 24202 being utilized to perform a surgical procedure. In such an aspect, the surgical instrument 24202 may comprise a plurality of components, including an end effector (e.g., Component-A 24216). The end effector 24216 may comprise a first jaw, a second jaw pivotably coupled to the first jaw, a cutting blade, and an integrated sensor 24213 configured to detect a tissue parameter associated with a function (e.g., dissect, clamp, coagulate, cut, staple, etc.) of the end effector 24216, and transmit the detected tissue parameter to a control circuit 24242 of the surgical hub 24240. Each of the plurality of components of the surgical instrument 24202 (e.g., Component-N 24218, e.g., a staple cartridge, etc.), including the end effector 24216, is also configured to transmit its respective device parameter(s) (e.g., 24219 and 24217, respectively) to the surgical hub 24240. Notably, it should be appreciated that a sensor (e.g., 24213), as referenced herein and in other disclosed aspects, may comprise a plurality of sensors configured to detect a plurality tissue parameters associated with a plurality of end effector 24216 functions. As such, further, in such an aspect, the surgical hub control circuit 24242 may be configured to receive such parameter data (e.g., detected tissue parameter(s), device parameter of each component including the end effector, etc.) throughout the course of the surgical procedure. A detected tissue parameter may be received each time an associated end effector function (e.g., dissection, clamping, coagulation, cutting, stapling, etc.) is to be performed. The surgical hub control circuit 24242 may be further configured to receive data from an internal database (e.g., a surgical hub database 24249) and/or an external database (e.g., from a cloud database 24269) throughout the course of the surgical procedure. According to various aspects, the data received from the internal 24249 and/or external databases 24269 may comprise procedural data (e.g., steps to perform the surgical procedure, data indicating respective device parameters associated with the surgical procedure) and/or historical data (e.g., data indicating expected tissue parameters based on historical data associated with the surgical procedure, a patient's surgical history data, etc.). In various aspects, the procedural data may comprise current/recognized standard-of-care procedures for the surgical procedure, and the historical data may comprise preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for each received device parameter based on historical data associated with the surgical procedure (e.g., system-defined constraints). Based on the received data (e.g., parameter data, internal and/or external data, etc.), the surgical hub control circuit 24242 may be configured to continually derive inferences (e.g., contextual information) about the ongoing surgical procedure. Namely, the situationally aware surgical hub may be configured to, for example, record data pertaining to the surgical procedure for generating reports, verify the steps being taken by the surgeon to perform the surgical procedure, provide data or prompts (e.g., via a user interface associated with the surgical hub 24244 and/or 24254 and/or the surgical instrument 24214, 24224, and/or 24234) that may be pertinent for a particular procedural step, control a surgical instrument function, etc.
According to another aspect, a situationally aware surgical instrument (e.g., 24202) may be utilized to perform a surgical procedure. In such an aspect, as described herein, the surgical instrument 24202 may comprise a plurality of components, including an end effector 24216. The end effector may comprise a first jaw, a second jaw pivotably coupled to the first jaw, a cutting blade, and an integrated sensor 24213 configured to detect a tissue parameter associated with a function (e.g., dissect, clamp, coagulate, cut, staple, etc.) of the end effector 24216, and transmit the detected tissue parameter to a control circuit. Notably, in such an aspect, the detected tissue parameter may be transmitted to an integrated control circuit 24212 of the end effector 24216. Each of the plurality of components of the surgical instrument (e.g., Component-N 24218, e.g., the staple cartridge, etc.), including the end effector 24216, is configured to transmit its respective device parameter(s) to the integrated end effector control circuit 24212. In such an aspect, the integrated end effector control circuit 24212 may be configured to receive such parameter data (e.g., detected tissue parameter(s), device parameter(s) of each component, including the end effector) throughout the course of the surgical procedure. A detected tissue parameter may be received each time an associated end effector function (e.g., dissection, clamping, coagulation, cutting, stapling, etc.) is to be performed. The integrated end effector control circuit 24212 may be further configured to receive data from an internal database (e.g., end effector memory 24215) and/or an external database (e.g., from a cloud database 24269 via a surgical hub 24240, from a surgical hub database 24249, etc.) throughout the course of the surgical procedure. According to various aspects, the data received from the internal and/or external databases may comprise staple cartridge data (e.g., sizes and/or types of staples associated with a staple cartridge (e.g., 24218) for which a device parameter(s) has been received by the end effector control circuit 24212) and/or historical data (e.g., data indicating expected tissues and/or types of tissues to be stapled with those sizes and/or types of staples based on historical data). In various aspects, the internal and/or external data may comprise preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for each received device parameter based on historical data associated with the surgical procedure (e.g., system-defined constraints). In one example, the internal and/or external data may comprise preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for expected tissues and/or tissue types or for the sizes and/or types of staples associated with the device parameter of the staple cartridge (e.g., 24218) based on historical data (e.g., system-defined constraints). Based on the received data (e.g., parameter data, internal and/or external data, etc.), the end effector control circuit 24212 may be configured to continually derive inferences (e.g., contextual information) about the ongoing procedure. Notably, according to an alternative aspect, the integrated sensor 24213 of the end effector 24216 may transmit the detected tissue parameter(s) to a control circuit (e.g., 24222 and/or 24232) associated with another surgical instrument component, for example, a handle of the handle assembly 24230. In such an aspect, that other surgical instrument component control circuit (e.g., 24222 and/or 24232) may be similarly configured to perform the various aspects of the end effector control circuit 24212 as described above. In end, the situationally aware surgical instrument (e.g., 24202) may be configured to, for example, alert its user (e.g., via a user interface of the end effector 24214, via a user interface of another surgical instrument component 24224 and/or 24234, for example, the handle of the handle assembly 24230, or via a user interface 24244 associated with a surgical hub 24240 coupled to the surgical instrument 24202) of a discrepancy. For example, the discrepancy may include that a detected tissue parameter exceeds a preferred/ideal tissue parameter and/or a preferred/ideal tissue parameter range associated with those sizes and/or types of staples or those expected tissues and/or tissue types. As a further example, the situationally aware surgical instrument (e.g., 24202) may be configured to control a surgical instrument function based on the discrepancy. In accordance with at least one aspect, the situationally aware surgical instrument (e.g., 24202) may prevent a surgical function based on a discrepancy.
Inappropriate Device Placement
According to various aspects of the present disclosure, physiologic sensing (e.g., detected via one or more than one sensor) may indicate device placement concerns. More specifically, according to such aspects, a physiologic incompatibility may be present within/between a first jaw and a second jaw of an end effector (e.g., after clamping) and further functionality (e.g., coagulation, cutting, stapling, etc.) of the end effector may be prohibited/prevented.
According to various aspects, a surgical procedure may comprise the resection of target tissue (e.g., a tumor). Referring to
Furthermore, in various aspects, after a target surgical margin (e.g., 24004 and/or 24012) is established for a surgical procedure, it may be difficult to efficiently and/or accurately identify and resect the tumor and/or its target surgical margin during a surgical procedure. Referring again to
In one example, if the second sensor is positioned on/within the tumor (e.g., at a central position, 24006), the control circuit may be further configured to determine a margin distance between the second sensor and the target surgical margin established for the surgical procedure. In such an example, the control circuit may compare the dynamically calculated distance (e.g., between the first sensor and the second sensor) to that determined margin distance to efficiently and accurately locate the end effector (e.g., cutting blade) at the target surgical margin (e.g., when the dynamically calculated distance is equal to or substantially equal to the determined margin distance, the end effector is properly positioned). The control circuit may be configured to utilize such a technique to efficiently and accurately locate the end effector (e.g., the cutting blade) around the target surgical margin (e.g., during resection).
In another example, if the second sensor is positioned at the periphery of the tumor or a plurality of second sensors are positioned around a periphery of the tumor, e.g., 24008, the control circuit may be further configured to determine a margin distance between the second sensor(s) and the target surgical margin established for the surgical procedure. In such an example, the control circuit may compare the dynamically calculated distance (e.g., between the first sensor and the second sensor) to that determined margin distance to efficiently and accurately locate the end effector (e.g., cutting blade) at the target surgical margin (e.g., when the dynamically calculated distance is equal to or substantially equal to the determined margin distance, the end effector is properly positioned). The control circuit may be configured to utilize such a technique to efficiently and accurately locate the end effector (e.g., the cutting blade) around the target surgical margin (e.g., during resection). Such an aspect may be beneficial when the tumor is abnormally shaped.
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Inappropriate Device Selection/Proposed Use
According to various aspects of the present disclosure, physiologic sensing (e.g., detected via one or more than one sensor) may indicate surgical instrument/device selection concerns. More specifically, according to such aspects, a surgical device-tissue incompatibility may be present and further functionality (e.g., coagulation, cutting, stapling, etc.) of the end effector may be prohibited/prevented.
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According to various aspects, when assessing whether the selected stapler/device is optimal 24110, the control circuit executing/implementing the safety process 24100 may be configured to analyze each detected tissue parameter (e.g., detected via the one or more than one sensor described herein) in cooperation with each received device parameter associated with the selected stapler/device 24102 based on system-defined constraints. In addition, according to such aspects, the control circuit may be configured to analyze each detected tissue parameter (e.g., detected via the one or more than one sensor described herein) with the received device parameters associated with each other available stapler, each other available energy device, each other stapler component available for use with the selected stapler/device, etc., based on system-defined constraints. According to such aspects, the control circuit may be configured to determine whether one or more than one of the other available staplers, the other available energy devices, and/or the other stapler components available for use with the selected stapler/device are more optimal than the selected stapler/device 24102 and/or components of the selected stapler/device 24102 based on the detected tissue parameters.
In various aspects, a detected tissue parameter(s) may comprise, for example, a type of the tissue, a thickness of the tissue, a stiffness of the tissue, a location of the tissue, vascularization in the tissue, etc. and a received device parameter may comprise, for example, a type of staple cartridge, a color of the staple cartridge, adjuncts to the staple cartridge, a clamp load limit of the staple cartridge, a gap range for the staple cartridge, and a firing rate for the staple cartridge, etc. According to various aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for each received device parameter. For example, a preferred/ideal tissue thickness and/or preferred/ideal tissue thickness range may be associated with each staple cartridge color. In such an example, each staple cartridge color may indicate the types and/or sizes of staples in the staple cartridge. Here, a staple cartridge comprising short staples may not be optimal for thick tissue. According to further aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise a preferred/ideal clamp load limit and/or preferred/ideal clamp load limit range for each detected tissue type. For example, each staple cartridge associated with its respective clamp load limit may indicate the types of tissue it can optimally staple. Here, various combinations of received device parameters (e.g., type of staple cartridge, color of the staple cartridge, adjuncts to the staple cartridge, clamp load limit of the staple cartridge, gap range for the staple cartridge, firing rate for the staple cartridge, etc.) and detected tissue parameters (e.g. type of the tissue, thickness of the tissue, stiffness of the tissue, location of the tissue, vascularization in the tissue, etc.) and established system defined constraints (e.g., associated with received device parameters and/or detected tissue parameters based on historical data and/or procedural data accessed in the situationally aware surgical system) are contemplated by the present disclosure.
Referring again to
Similar to above, a detected tissue parameter may comprise, for example, a type of the tissue, a thickness of the tissue, a stiffness of the tissue, a location of the tissue, vascularization in the tissue, etc. and a received device parameter may comprise, for example, a type of staple cartridge, a color of the staple cartridge, adjuncts to the staple cartridge, a clamp load limit of the staple cartridge, a gap range for the staple cartridge, and a firing rate for the staple cartridge, etc. According to various aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for each received device parameter. For example, a preferred/ideal tissue thickness and/or preferred/ideal tissue thickness range may be associated with each staple cartridge color. In such an example, each staple cartridge color may indicate the types and/or sizes of staples in the staple cartridge. Here, continuing the example, if a received device parameter of the selected stapler/device 24102 comprises a staple cartridge color (e.g., indicating short staples) and the detected tissue parameter indicates a tissue thickness exceeding the preferred/ideal tissue thickness and/or the preferred/ideal tissue thickness range associated with the staple cartridge color of the selected stapler/device 24102, a safety issue exists with the selected stapler/device 24102. Utilizing an inappropriate staple cartridge may lead to less than satisfactory results and/or undesired results (e.g., failed stapling, oozing, bleeding, etc.). In such an instance, the control circuit may be configured to warn the surgeon 24118 (e.g., referring to
Similar to above, according to further aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise a preferred/ideal clamp load limit and/or preferred/ideal clamp load limit range for each detected tissue type. For example, each staple cartridge associated with its respective clamp load limit may indicate the types of tissue it can optimally staple. Here, continuing the example, if a received device parameter of the selected stapler/device 24102 comprises its staple cartridge clamp load limit and the tissue identified by the tissue identification process 24108 indicates a tissue type requiring a staple cartridge with a higher clamp load limit, a safety issue exists with the selected stapler/device 24102. Utilizing an inappropriate staple cartridge may lead to less than satisfactory results and/or undesired results (e.g., failed stapling, oozing, bleeding, etc.). In such an instance, the control circuit may be configured to warn the surgeon 24118 (e.g., referring to
Referring back to
According to various other aspects, although discussed specifically with respect to a stapler/device herein, the present disclosure should not be so limited. More specifically, the disclosed aspects similarly apply to other surgical instruments including energy devices (e.g. RF and/or ultrasonic surgical instruments) and/or their respective components and/or endoscopic devices and/or their respective components.
Various aspects of the subject matter described herein “SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING” are set out under the heading in the following examples:
A surgical system comprises a control circuit and a surgical instrument. The surgical instrument comprises a plurality of components and a sensor. Each of the plurality of components of the surgical instrument comprises a device parameter. Each component is configured to transmit its respective device parameter to the control circuit. The sensor is configured to detect a tissue parameter associated with a proposed function of the surgical instrument and transmit the detected tissue parameter to the control circuit. The control circuit is configured to analyze the detected tissue parameter in cooperation with each respective device parameter based on a system-defined constraint. The surgical system further comprises a user interface configured to indicate whether the surgical instrument comprising the plurality of components is appropriate to perform the proposed function.
The surgical system of Example 1, wherein the detected tissue parameter comprises at least one of a type of the tissue, a thickness of the tissue, a stiffness of the tissue, a location of the tissue, or vascularization of the tissue.
The surgical system of Example 1 or 2, wherein a component of the surgical instrument includes a staple cartridge, and wherein the device parameter includes at least one of a type of the staple cartridge, a color of the staple cartridge, adjuncts to the staple cartridge, a clamp load limit of the staple cartridge, a gap range for the staple cartridge, and a firing rate for the staple cartridge.
The surgical system of Example 1, 2, or 3, wherein a component of the surgical instrument includes an end effector, and wherein the detected tissue parameter comprises at least one of a closure angle of the end effector on the tissue, a length of the tissue in contact with a tissue-contacting surface of the end effector, and a force to compress the tissue within the end effector.
The surgical system of Example 4, wherein the control circuit is further configured to identify the tissue as parenchyma, vessel or bronchus based on the at least one detected tissue parameter.
The surgical system of Example 1, 2, 3, 4, or 5, wherein the control circuit is further configured to recommend at least one alternative component for use with the surgical instrument to perform the proposed function.
The surgical system of Example 1, 2, 3, 4, 5, or 6, wherein the system-defined constraint comprises at least one of a predetermined tissue parameter or a predetermined tissue parameter range associated with each transmitted device parameter.
The surgical system of Example 1, 2, 3, 4, 5, 6, or 7, wherein the control circuit is further configured to prevent the proposed function when the system-defined constraint is exceeded.
The surgical system of Example 8, wherein the user interface comprises a user-interface element selectable to override the control circuit to permit the proposed function of the surgical instrument.
The surgical system of Example 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the proposed function of the surgical instrument comprises one or more than one of clamping the tissue, coagulating the tissue, cutting the tissue, and stapling the tissue.
The surgical system of Example, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10, further comprising a surgical hub communicatively coupled to the surgical instrument, wherein the surgical hub comprises the control circuit.
The surgical system of Example 11, wherein one of the surgical instrument or the surgical hub comprises the user interface.
A surgical system comprises a surgical hub and a surgical instrument communicatively coupled to the surgical hub. The surgical instrument comprises a plurality of components and a sensor. Each of the plurality of components of the surgical instrument comprises a device parameter. Each component is configured to transmit its respective device parameter to the surgical hub. The sensor is configured to detect a tissue parameter associated with a proposed function of the surgical instrument and transmit the detected tissue parameter to the surgical hub. The surgical hub comprises a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to analyze the detected tissue parameter in cooperation with each respective device parameter based on a system-defined constraint. The surgical system further comprises a user interface configured to indicate whether the surgical instrument comprising the plurality of components is appropriate to perform the proposed function.
The surgical system of Example 13, wherein the detected tissue parameter comprises at least one of a type of the tissue, a thickness of the tissue, a stiffness of the tissue, a location of the tissue, or vascularization of the tissue.
The surgical system of Example 13 or 14, wherein a component of the surgical instrument includes a staple cartridge, and wherein the device parameter includes at least one of a type of the staple cartridge, a color of the staple cartridge, adjuncts to the staple cartridge, a clamp load limit of the staple cartridge, a gap range for the staple cartridge, and a firing rate for the staple cartridge.
The surgical system of Example 13, 14, or 15, wherein a component of the surgical instrument includes an end effector, and wherein the detected tissue parameter comprises at least one of a closure angle of the end effector on the tissue, a length of the tissue in contact with a tissue-contacting surface of the end effector, and a force to compress the tissue within the end effector.
The surgical system of Example 13, 14, 15, or 16, wherein the instructions are further executable by the processor of the surgical hub to recommend at least one alternative component for use with the surgical instrument to perform the proposed function.
The surgical system of Example 13, 14, 15, 16, or 17, wherein the instructions are further executable by the processor of the surgical hub to prevent the proposed function when the system-defined constraint is exceeded.
A non-transitory computer readable medium stores computer readable instructions which, when executed, causes a machine to analyze a detected tissue parameter in cooperation with a device parameter, of each of a plurality of components of a surgical instrument of a surgical system, based on a system-defined constraint, wherein the detected tissue parameter is associated with a proposed function of the surgical instrument. The surgical system includes the surgical instrument which includes a plurality of components. Each component is configured to transmit its respective device parameter to the machine. The surgical system further includes a sensor configured to detect the detected tissue parameter and transmit the detected tissue parameter to the machine. The instructions, when executed, further cause the machine to generate a user interface, wherein the user interface provides an indication whether the surgical instrument including the plurality of components is appropriate to perform the proposed function of the surgical system.
The non-transitory computer readable medium of Example 19, wherein the instructions, when executed, further cause the machine to generate an override element on the user interface, wherein the override element is selectable to permit the proposed function of the surgical instrument.
Compression Rate to Determine Tissue Integrity
In various aspects, a surgical instrument can detect a variety of different variables or parameters associated with the closure of the jaws of the surgical instrument, which can in turn be utilized to adjust or affect various operational parameters that dictate how the surgical instrument functions. The rate at which the jaws of a surgical instrument are transitioned from the open position to the closed position to clamp tissue therebetween can be defined as the clamping rate or closure rate. In various aspects, the closure rate can be variable or constant during the course of an instance of the jaws closing. A threshold against which a particular parameter associated with the closure of the jaws is compared can be defined as a closure threshold.
Clamping tissue at an inappropriate closure rate or with inappropriate closure thresholds can result in damage to the tissue (e.g., the tissue can be torn due to the jaws applying too much force to the tissue) and/or operational failures by the surgical instrument (e.g., staples can be malformed due to the tissue not being fixedly held by the jaws as the staples are fired). Accordingly, in some aspects the surgical instrument is configured to detect the characteristics of the tissue being clamped by the surgical instrument and adjust the closure rate(s), closure threshold(s), and other operational parameters correspondingly. Further, each surgical procedure can involve multiple different tissue types and/or tissues with different characteristics. Accordingly, in some aspects the surgical instrument is configured to dynamically detect the tissue characteristics each time a tissue is clamped and adjust the closure rate(s), closure threshold(s), and other operational parameters correspondingly.
The present disclosure provides at least one solution, wherein a surgical instrument is configured to detect parameters associated with the compression of the tissue being clamped by the end effector. The surgical instrument can further be configured to differentiate between tissues exhibiting different integrities according to the detected tissue compression characteristics. The motor can then be controlled to affect the jaw closure rate and/or provide feedback to the user according to the integrity of the tissue. For example, the surgical instrument can be configured to decrease the closure rate of the jaws if the detected tissue compression characteristics indicate that the tissue is stiff and/or provide a suggestion to the user to utilize adjunct reinforcement if the tissue compression characteristics indicate that the tissue has low shear strength.
In various aspects, the sensor(s) 21004 can be configured to detect the compression parameters of a tissue clamped at the end effector. In one aspect, the sensor(s) 21004 can be configured to detect the force to close (FTC) the jaws of the end effector 21008, i.e., the force exerted to transition the jaws from the open configuration to the closed configuration. For example, the sensor(s) 21004 can include a motor current sensor configured to detect the current drawn by the motor, such as is discussed with respect to
The control circuit 21002 can be configured to adjust the closure rate of the jaws of the end effector 21008 to accommodate different tissue types. The control circuit 21002 can be configured to monitor the compression force exerted on the tissue (e.g., FTC) or another parameter associated with the compression of the tissue (e.g., tissue impedance) over an initial period of compression and, based on the rate of change of the tissue compression parameter, adjust the jaw closure rate or time accordingly. For example, it may be beneficial to lower the closure rate or increase the closure time for more viscoelastic tissues, rather than apply the total compressive force over a short period of time, as discussed above with respect to
Accordingly, the control circuit 21002 determines how the value of the sensed tissue compression parameter compares to one or more thresholds and then generates a response accordingly. In one aspect, the control circuit 21002 determines 21054 the value of the sensed tissue compression parameter relative to a first threshold. For example, the control circuit 21002 can determine 21054 whether the sensed tissue compression parameter exceeds or is greater than a first or upper threshold. In one aspect, if the sensed tissue compression parameter exceeds the first threshold, then the process 21050 proceeds along the YES branch and the control circuit 21002 controls 21056 the motor 21006 to increase the length of time taken to close the jaws of the end effector 21008. The control circuit 21002 can control 21056 the motor 21006 to increase the jaw closure time by, for example, decreasing the rate at which the jaws are closed, increasing the length of time that the movement of the jaws is paused after the initial clamping of the tissue (i.e., the tissue creep wait time), or lowering the stabilization threshold to end the clamping phase. If the sensed tissue compression parameter does not exceed the first threshold, then the process 21050 proceeds along the NO branch and, in various aspects, the process 21050 can end or the process 21050 can continue and the control circuit 21002 can compare the value of the sensed tissue compression to one or more additional thresholds or continue receiving 21052 tissue parameter data and/or signals.
In another aspect, the control circuit 21002 further determines 21058 the value of the sensed tissue compression parameter relative to a second threshold. For example, the control circuit 21002 can determine 21058 whether the sensed tissue compression parameter is below or is less than a second or lower threshold. In one aspect, if the sensed tissue parameter is below the second threshold, then the process 21050 proceeds along the YES branch and the control circuit 21002 provides 21060 corresponding feedback via, for example, the user interface 21010. The provided 21060 feedback can include, for example, visual feedback provided via a display or audio feedback provided by a speaker. In one aspect, the feedback can suggest that the user take one or more corrective actions to ameliorate the situation resulting in the sensed tissue compression parameter being unexpectedly low. Such corrective action can include, for example, utilizing adjunct reinforcement (i.e., a tissue thickness compensator), such as is disclosed in U.S. Pat. No. 8,657,176, titled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER, which is hereby incorporated by reference herein. Adjunct reinforcement can, in various aspects, comprise a layer or series of layers of compressible material configured to adapt and/or apply an additional compressive force to the tissue captured between the anvil 150306 (
The thresholds discussed above can include, for example, values for the parameter(s) sensed by the sensor(s) 21004 and/or derivatives of the parameter(s) sensed by the sensor(s) 21004 (e.g., the time rate change of a sensed parameter). In aspects where the tissue compression parameter includes FTC the end effector 21008, the first threshold can indicate the delineation above which the clamped tissue is considered stiff. Stiff tissue can be relatively prone to tearing, either due to the mechanical actions of the jaws on the tissue or, for lung tissue, during re-inflation. Further, the second threshold can indicate the delineation below which the clamped tissue is considered to have a weak shear strength (i.e., is squishy). Tissue having weak shear strength can be relatively difficult for the end effector 21008 to securely grasp or otherwise hold in place during stapling and/or firing of the cutting member (i.e., I-beam 150178 with cutting edge 150182).
It should be noted that although the steps of the particular example of the process 21050 in
For the first firing 21110, the control circuit 21002 executing the process illustrated in
For the second firing 21114 (which may be a firing utilizing a tissue compensator subsequent to the first firing 21110), the control circuit 21002 executing the process 21050 illustrated in
For the third firing 21116, the control circuit 21002 executing the process illustrated in
The time at which the control circuit 21002 executing the aforementioned algorithm or process determines compares the parameter sensed by the sensor(s) 21004 to one or more thresholds can include a discrete instance during the firing stroke of the surgical instrument 21000, a series of discrete instances during the firing stroke, and/or a continuous time interval during the firing stroke. The tissue compression parameter monitored by the control circuit 21002 and compared against a threshold can include, for example, a FTC value (e.g., the second threshold 21108 depicted in
In one aspect, the control circuit 21002 can be further configured to store data related to the firings of the surgical instrument 21000 and then optionally utilize the data from the previous firings to adjust an algorithm for determining the tissue integrity of a clamped tissue. For example, the data from the previous firings can be utilized to adjust the first and/or second thresholds of the process 21050 depicted in
The techniques described hereabove allow the surgical instrument 21000 to avoid damaging clamped tissue and prevent operational failures (e.g., malformed staples) resulting from jaw closure rates that are inappropriate or non-ideal for the particular characteristics of the tissue being operated on. Further, the techniques described hereabove improve the ability of the surgical instrument to respond appropriately to the characteristics of the tissues encountered during the course of a surgical procedure.
Tissue Initial Contact to Determine Tissue Type
Clamping tissue at an inappropriate closure rate or with inappropriate closure thresholds can result in damage to the tissue (e.g., the tissue can be torn due to the jaws applying too much force to the tissue) and/or operational failures by the surgical instrument (e.g., staples can be malformed due to the tissue not being fixedly held by the jaws as the staples are fired). Accordingly, in some aspects the surgical instrument is configured to detect the characteristics of the tissue being clamped by the surgical instrument and adjust the closure rate(s), closure threshold(s), and other operational parameters correspondingly. Further, each surgical procedure can involve multiple different tissue types and/or tissues with different characteristics. Accordingly, in some aspects the surgical instrument is configured to dynamically detect the tissue characteristics each time a tissue is clamped and adjust the closure rate(s), closure threshold(s), and other operational parameters correspondingly.
The present disclosure provides at least one solution, wherein a surgical instrument is configured characterize the tissue type of the tissue being clamped according to the degree of tissue contact against the surfaces of the jaws and the relative positions of the jaws at the initial point in contact with the tissue. The closure rate for the jaws and the threshold for adjusting the jaw closure rate can then be set to appropriate levels for the tissue type characterized by the detected degree of tissue contact and the detected position of the jaws. For example, the surgical instrument can be configured to differentiate between parenchyma and vessels because parenchyma contacts a greater degree of the surfaces of the jaws and the jaws at a larger angle at the point of initial contact as compared to vessels. The surgical instrument can then control the motor to affect the jaw closure rate and adjustment threshold accordingly for the detected tissue type.
Referring back to
In various aspects, the sensor(s) 21004 can be configured to detect physical contact of a tissue against the surface of the jaws of the end effector 21008. In one aspect, the sensor(s) 21004 can include one or more tissue contact sensors disposed along the tissue-contacting surfaces of the end effector 21008, such as the anvil and the cartridge or channel. The tissue contact sensors can include, for example, a plurality of sensors or segments of a segmented circuit arranged sequentially along the surfaces of the jaws that are each configured to determine whether tissue is positioned thereagainst, such as is discussed above with respect to
Accordingly, the control circuit 21002 determines 21206 the position of the jaws at the initial tissue contact point. In one aspect, the control circuit 21002 is communicably coupled to a Hall effect sensor disposed on one of the jaws of the end effector 21008 that is configured to detect the relative position of a corresponding magnetic element disposed on the opposing jaw, such as is discussed with respect to
Accordingly, the control circuit 21002 determines 21208 the degree of contact between the grasped tissue and the tissue-contacting surface(s) of the jaws. The degree of tissue contact can correspond to the number or ratio of the sensors 21004 that have detected the presence (or absence) of tissue, such as is discussed with respect to
Accordingly, the control circuit 21002 sets 21210 control parameters for the motor 21006 according to the determined 21206 position of the jaws and the determined 21208 degree of tissue contact. The motor control parameters can include, for example, the time to close the jaws and/or closure threshold(s). In one aspect, the control circuit 21002 can be configured to perform a runtime calculation and/or access a memory (e.g., a lookup table) to retrieve the motor control parameters (e.g., the jaw closure rate and closure threshold) associated with the particular position of the jaws and the particular degree of tissue contact sensed via the various sensors. In various aspects, the control circuit 21002 can control the motor 21006 to adjust the jaw closure time by, for example, adjusting the rate at which the jaws are transitioned from the open position to the closed position, adjusting the length of time that the jaws are paused after the initial clamping of the tissue (i.e., the tissue creep wait time), and/or adjusting the stabilization threshold that ends the clamping phase. In various aspects, the closure threshold(s) can include, for example, the maximum allowable FTC the end effector 21008 or rate of change for the FTC (i.e., ΔFTC) at which the control circuit 21002 stops the motor 21006 driving the closure of the jaws or takes other actions, as discussed above under the heading “Compression Rate to Determine Tissue Integrity.” The control circuit 21002 can then control the motor 21206 according to the motor control parameters set 21210 by the process 21200.
The position of the jaws and the degree of contact with the tissue at the initial point of contact with the tissue corresponds to the thickness or geometry of the tissue being grasped, which in turn corresponds to the physiological type of the tissue. Thus, the control circuit 21002 can be configured to differentiate between tissue types and then set 21210 the control parameters for the motor 21006 accordingly. For example, the control circuit 21002 can be configured to determine whether parenchyma or vessel tissue has been grasped by the end effector 21008 and then set 21210 motor control parameters that are appropriate for the detected tissue type.
In some aspects, jaw closure rate can be selected for each tissue type to maintain the maximum FTC and/or ΔFTC under a particular closure threshold, which can likewise be selected for each tissue type. In one aspect, the control circuit 21002 can be configured to institute a minimum clamp rate so that the closure motion of the jaws is never permanently halted. In one aspect, the control circuit 21002 can be configured to control the maximum pause times to ensure that jaw closure progresses at least a default rate. In one aspect, the control circuit 21002 can be configured to halt the motor 21006 and/or provide feedback to the user when closure threshold(s) are exceeded or otherwise beached during user of the surgical instrument 21000.
It should be noted that although the steps of the particular example of the process 21200 in
In some aspects where the surgical instrument 21000 includes a control circuit 21002 executing the process 21200 described above in
A first firing of a surgical instrument 21000 can be represented by a first FTC curve 21310 and a corresponding first velocity curve 21310′, which illustrate the change in FTC and closure velocity over time during the course of the first firing, respectively. The first firing can represent, for example, a default firing of the surgical instrument 21000 or a firing of the surgical instrument 21000 that does not include a control circuit 21002 executing the process 21200 depicted in
A second firing of a surgical instrument 21000 can be represented by a second FTC curve 21324 and a corresponding first velocity curve 21324′, which illustrate the change in FTC and closure velocity over time during the course of the second firing, respectively. In contrast to the first firing, the second firing can represent, for example, a firing of the surgical instrument 21000 that includes a control circuit 21002 executing the process depicted in
As the anvil 21012 is driven from the open position, it makes contact with the clamped tissue that, for this particular firing, is parenchyma 21030. As the anvil 21012 contacts the tissue being clamped at time t0, the FTC increases 21326 from an initial FTC (e.g., zero) to a first peak 21328 at time t2. It should be noted that the FTC increases 21326 more slowly during the second firing as compared to the first firing because the control circuit 21002 executing the process 21200 selected a first or initial closure velocity vp1 in the second firing that was appropriate for the type of tissue being clamped, which thereby reduces the amount of force exerted on the tissue as compared to an unmodified firing of the surgical instrument 21000. At time t2, the control circuit 21002 of the surgical instrument 21000 determines that the FTC has reached or exceeded a FTC threshold FTC (which had been set by the control circuit 21002 on or after t0 when the control circuit 21002 determined that parenchyma 21030 tissue was being clamped). The parenchyma FTC threshold FTC can represent, for example, the maximum force that can be safely or desirably exerted on parenchyma 21030 tissue. Accordingly, the control circuit 21002 controls the motor 21006 to halt the movement of the anvil 21012, causing the closure velocity to drop 21338 to zero. The movement of the anvil 21012 can be paused for a duration p2, during which time the closure velocity is maintained 21340 at zero. During the pause, the FTC gradually decreases 21330 as the clamped tissue relaxes. The pause duration p2 can be equal to a default pause duration (e.g., p1) or a closure parameter selected by the control circuit 21002 for parenchyma 21030 tissue.
After the pause duration p2 has elapsed at time t3, the control circuit 21002 re-engages the motor 21006 and resumes closing the anvil 21012. Accordingly, the closure velocity increases 21342 to a second closure velocity vp2. In some aspects, after the parenchyma FTC threshold FTC is first exceeded, the control circuit 21002 reduces the closure velocity at which the anvil 21012 is closed to a second closure velocity vp2 that is specific to parenchyma 21030 tissue, wherein vp2<vp1. The control circuit 21002 can be configured to close the anvil 21012 at a lower velocity subsequent to the parenchyma FTC threshold FTC being exceeded because that may indicate that the tissue is thicker, stiffer, or otherwise more resistant to the closure forces from the anvil 21012 than expected for the detected tissue type. Thus, it may be desirable to reduce the closure velocity to attempt to reduce the amount of closure forces subsequently exerted on the tissue being clamped.
As the anvil 21012 resumes closing at time t3, the FTC once again begins increasing until it peaks 21332 at time t4 and once again reaches or exceeds the parenchyma force threshold FTCp. At time t4, the control circuit 21002 of the surgical instrument 21000 determines that the FTC has reached or exceeded the FTC threshold FTCp. Accordingly, the control circuit 21002 controls the motor 21006 halt the movement of the anvil 21012, causing the closure velocity to drop 21346 to zero. The movement of the anvil 21012 can be paused for a duration p3, during which time the closure velocity is maintained 21348 at zero. During the pause, the FTC gradually decreases 21334 as the clamped tissue relaxes.
A third firing of a surgical instrument 21000 can be represented by a third FTC curve 21360 and a corresponding first velocity curve 21360′, which illustrate the change in FTC and closure velocity over time during the course of the third firing, respectively. The third firing can represent, for example, a default firing of the surgical instrument 21000 or a firing of the surgical instrument 21000 that does not include a control circuit 21002 executing the process depicted in
A fourth firing of a surgical instrument 21000 can be represented by a second FTC curve 21375 and a corresponding first velocity curve 21375′, which illustrate the change in FTC and closure velocity over time during the course of the second firing, respectively. In contrast to the first firing, the fourth firing can represent, for example, a firing of the surgical instrument 21000 that includes a control circuit 21002 executing the process 21200 depicted in
As the anvil 21012 is driven from the open position, the FTC is initially flat 21376 because the anvil 21012 travels for a period of time without contacting the tissue. Once the anvil 21012 contacts the tissue at time t0, the FTC increases 21378 from an initial FTC (e.g., zero). After contacting the vessel 21032, the control circuit 21002 executing the process 21200 illustrated in
As the anvil 21012 advances at the lower vessel closure velocity vv1, the FTC increases 21380 more slowly than previously until it peaks 21382 at time t3. At time t3, the control circuit 21002 determines that the FTC has reached or exceeded a FTC threshold FTCv (which had been set by the control circuit 21002 on or after t0 when the control circuit 21002 determined that a vessel 21032 was being clamped). The vessel FTC threshold FTCv can represent, for example, the maximum force that can be safely or desirably exerted on a vessel 21032 tissue. Accordingly, the control circuit 21002 controls the motor 21006 halt the movement of the anvil 21012, causing the closure velocity to drop 21932 to zero. The movement of the anvil 21012 can be paused for a duration p5, during which time the closure velocity is maintained 21394 at zero. During the pause, the FTC gradually decreases 21384 as the clamped tissue relaxes. The pause duration p5 can be equal to a default pause duration (e.g., p1) or a closure parameter selected by the control circuit 21002 for vessel 21032 tissue.
In sum,
A fifth firing of a surgical instrument 21000 can be represented by a fifth FTC curve 21408 and a corresponding fifth velocity curve 21408′, which illustrate the change in FTC and closure velocity over time during the course of the fifth firing, respectively. The fifth firing can represent, for example, a firing of the surgical instrument 21000 that includes a control circuit 21002 executing the process depicted in
The fifth firing thus represents a firing of the surgical instrument 21000 wherein none of the FTC threshold, the ΔFTC threshold, or any other closure threshold is reached or exceeded during closure of the jaws 21013. In other words, the fifth firing stays within all control parameters during the course of the jaws 21013 closing. Thus, the control circuit 21002 does not pause the anvil 21012, adjust the closure velocity of the anvil 21012, or take any other corrective action during the course of the jaws 21013 closing.
A sixth firing of a surgical instrument 21000 can be represented by a sixth FTC curve 21424 and a corresponding sixth velocity curve 21424′, which illustrate the change in FTC and closure velocity over time during the course of the sixth firing, respectively. The sixth firing can represent, for example, a firing of the surgical instrument 21000 that includes a control circuit 21002 executing the process 21200 depicted in
A seventh firing of a surgical instrument 21000 can be represented by a seventh FTC curve 21440 and a corresponding seventh velocity curve 21440′, which illustrate the change in FTC and closure velocity over time during the course of the seventh firing, respectively. The seventh firing can represent, for example, a firing of the surgical instrument 21000 that includes a control circuit 21002 executing the process 21200 depicted in
Accordingly, the control circuit 21002 controls the motor 21006 to drop 21452 the closure velocity of the anvil 21012 to a second closure velocity v2, wherein v1>v2. From t1 onwards, the drop in the closure velocity results in the FTC increasing 21444 at a slower rate. The FTC increases 21444 until it peaks 21446 below the FTC threshold FTCT and then decreases thereafter. As the seventh firing remains within all closure parameters after t1, the closure velocity is maintained 21454 at the second closure velocity v2 until the tissue is fully clamped, at which point the control circuit 21002 controls the motor 21006 to halt the closure of the anvil 21012 and the closure velocity drops 21456 to zero.
Various aspects of the subject matter described herein under the heading “Controlling a surgical instrument according to sensed closure parameters” are set out in the following examples:
A surgical instrument comprises an end effector comprising jaws transitionable between an open configuration and a closed configuration. The surgical instrument further comprises a motor operably coupled to the jaws. The motor configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further comprises a sensor configured to transmit at least one signal indicative of a tissue compression parameter associated with a tissue between the jaws. The surgical instrument further comprises a control circuit coupled to the sensor and the motor. The control circuit is configured to receive the at least one signal, determine a value of the tissue compression parameter based on the at least one signal as the jaws transition from the open configuration to the closed configuration, cause the motor to increase a time to transition the jaws to the closed configuration according to whether the value of the tissue compression parameter is above a first threshold, and provide feedback according to whether the value of the tissue compression parameter is below a second threshold.
The surgical instrument of Example 1, wherein the tissue compression parameter comprises a force exerted by the motor to transition the jaws to the closed configuration.
The surgical instrument of Example 1, wherein the tissue compression parameter comprises a time rate of change of a force exerted by the motor to transition the jaws to the closed configuration.
The surgical instrument of Example 1, 2, or 3, wherein the feedback comprises a suggestion for adjunct reinforcement.
The surgical instrument of Example 1, 2, 3, or 4, wherein the control circuit is configured to increase the time to transition the jaws to the closed configuration by decreasing a rate at which the motor transitions the jaws to the closed configuration.
The surgical instrument of Example 1, 2, 3, or 4, wherein the control circuit is configured to increase the time to transition the jaws to the closed configuration by increasing a length of time that the motor is paused when transitioning the jaws to the closed configuration.
The surgical instrument of Example 1, 2, 3, or 4, wherein the control circuit is configured to increase the time to transition the jaws to the closed configuration by lowering a stabilization threshold to stop the motor in transitioning the jaws to the closed configuration.
A surgical instrument comprising an end effector. The end effector comprises jaws transitionable between an open configuration and a closed configuration and one or more sensors disposed along a tissue contacting surface of each of the jaws. The one or more sensors are configured to detect contact with a tissue. The surgical instrument further comprises a motor operably coupled to the jaws. The motor configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further comprises a control circuit coupled to the one or more sensors and the motor. The control circuit is configured to determine an initial contact point at which the tissue contacts the tissue contacting surfaces of the jaws, determine a separation between the jaws at the initial contact point, determine a degree of contact between the tissue contacting surfaces and the tissue, cause the motor to transition the jaws to the closed configuration at a rate corresponding to the separation between the jaws and the degree of contact between the tissue contacting surfaces and the tissue at the initial contact point, and cause the motor to adjust the rate at which the jaws are transitioned to the closed configuration according to whether a force exerted by the motor to transition the jaws to the closed configuration exceeds a threshold. The threshold corresponds to the separation between the jaws and the degree of contact between the tissue contacting surfaces and the tissue at the initial contact point.
The surgical instrument of Example 8, wherein the one or more sensors comprise pressure sensors.
The surgical instrument of Example 8, wherein the one or more sensors comprise impedance sensors.
The surgical instrument of Example 8, 9, or 10, wherein the separation between the jaws comprises an angle between the jaws.
The surgical instrument of Example 8, 9, or 10, wherein the separation between the jaws comprises a gap between the jaws.
A surgical instrument comprises an end effector. The end effector comprises jaws configured to transition between an open configuration and a closed configuration to grasp a tissue and a contact sensor assembly configured to sense the tissue thereagainst. The surgical instrument further comprises a position sensor configured to sense a configuration of the jaws and a motor coupled to the jaws. The motor is configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further comprises a control circuit coupled to the contact sensor assembly, the position sensor, and the motor. The control circuit is configured to determine an initial contact point at which the tissue contacts the jaws, determine the configuration of the jaws via the position sensor at the initial contact point, determine an amount of tissue contact between the tissue and the jaws via the contact sensor assembly at the initial contact point, set a closure rate at which the motor transitions the jaws to the closed configuration according to the configuration of the jaws and the amount of tissue contact at the initial contact point, set a closure threshold according to the configuration of the jaws and the amount of tissue contact at the initial contact point, and control the motor according to a force exerted by the motor to transition the jaws to the closed configuration relative to a threshold.
The surgical instrument of Example 13, wherein the sensor assembly comprises a pressure sensor.
The surgical instrument of Example 13, wherein the sensor assembly comprises an impedance sensor.
The surgical instrument of Example 13, 14, or 15, wherein the configuration of the jaws corresponds to an angle between the jaws.
The surgical instrument of Example 13, 14, or 15, wherein the configuration of the jaws corresponds to a gap between the jaws.
Aspects of the present disclosure are presented for adjusting the closure threshold and closure rate implemented by a closure control program executed by a control circuit of a surgical instrument, where the adjustment is made based on preoperative information. Adjusting closure thresholds may be one example of performing situational awareness by the computer-implemented interactive surgical system (including one or more surgical systems 102 and cloud based analytics medical system such as cloud 104, 204, which is referred to as cloud 104 for the sake of clarity). For example, closure thresholds can be adjusted to a patient specific closure threshold based on perioperative information received from the cloud 104 or determined by surgical hubs or surgical instruments. As used herein, perioperative information comprises preoperative, intraoperative information, and postoperative information.
Preoperative information refers to information received prior to performance of a surgical operation with a surgical instrument, while intraoperative information refers to information received during a surgical operation (e.g., while a step of the surgical operation is being performed). In particular, the computer-implemented interactive surgical system can determine or infer end effector closure parameters, such as an appropriate end effector closure threshold and closure rate algorithm, for particular handheld intelligent surgical instruments. Such inferences can be based on contextual information pertaining to a surgical procedure to be performed and pertaining to the corresponding patient. Contextual information can include or be determined based on perioperative information. The surgical instruments may be any suitable surgical instrument described in the present disclosure, such as surgical instrument 112, 600, 700, 750, 790, 150010. For the sake of clarity, surgical instrument 112 is referenced.
Perioperative information, such as perioperatively diagnosed diseases and treatments, may affect the properties or characteristics of tissue being treated by the surgical instrument 112. For example, a patient may have been previously diagnosed with cancer and have received radiation treatments to treat the cancer. Accordingly, this preoperative information would indicate that the patient's tissue may have an increased stiffness characteristic. However, the currently applied closure control program may not address this increased stiffness. Consequently, using the closure control program to perform a surgical procedure according to a general closure rate algorithm could result in unnecessary trauma or damage to tissue due to excessive compression of the patient's tissue. Additionally, during a surgical operation, intraoperative information may be analyzed, such as by identifying which tissue type of multiple potential types of tissue is being treated. Different types of tissue may also have different tissue characteristics such as tissue stiffness. Accordingly, changes in intraoperative information may be used for executing intraoperative adjustments alternatively or additionally to perioperative adjustments. In sum, closure control programs might not consider that different closure rate thresholds should be applied depending on perioperative information, such as the tissue type, surgical procedure being performed and surgical steps already performed.
It may be desirable for a surgical instrument to account for different tissue types and the various characteristics of such different tissue types when a surgical operation is performed with the surgical instrument 112. In particular, it may be desirable for the surgical instrument 112 to effectively determine the tissue type and characteristics of that tissue type prior to the clinician performing a surgical operation with the surgical instrument as well as during the performance of a surgical operation.
Accordingly, in some aspects, a cloud based analytics medical system (e.g., computer-implemented interactive surgical system 100) is provided in which perioperative information may be considered to determine the type of tissue to be treated and the characteristics of the treated tissue prior to treatment. For example, the surgical procedure to be performed and other patient information may be instances of preoperative information retrieved before the surgical procedure is performed. Previous performed steps of a surgical operation, other surgical history, and a change in tissue type are examples of intraoperative information that may be considered. In general, this perioperative information may be used in conjunction with sensor signals indicative of a closure parameter to determine, infer, or adjust parameters of an end effector (e.g., closure rate of change and closure threshold) of the surgical instrument 112. The end effector may be any end effector described in the present disclosure, such as end effector 702, 151600, 150300, 151340, 152000, 152100, 152150, 152200, 152300, 152350, 152400, 153460, 153470, 153502. For the sake of clarity, end effector 702 is referenced.
Analyzing perioperative information for closure rate related situational awareness could be achieved in a number of ways. Based on perioperative information, a control circuit such as control circuit 500, 710, 760, 150700 (discussed above with respect to
The surgical hub 106 may then analyze the received perioperative information. Based on this analysis, the surgical hub 106 could then transmit a signal to the surgical instrument 112 to adjust the closure rate of change and closure threshold inputs used in the selected closure control program. The surgical hub 106 could also instruct the surgical instrument 112 to select a different closure control program, such as by the control circuit selecting a different control program. The selection of a different control program can be based on a signal received from the hub 106 or by the surgical instrument 112 receiving an updated control program from the hub 106. The cloud 104 could also perform the analysis for adjusting the closure rate and maximum threshold used. In particular, the processors of the cloud 104 may analyze perioperative information to determine tissue type and characteristics for altering the inputs to a closure control program or selecting a different suitable closure control program to be executed by the surgical instrument, for example.
In this way, the surgical instrument 112 may be instructed by the cloud 104 (via the hub 106, for example) to apply a suitable closure rate algorithm and closure maximum threshold. The tissue type and characteristics may further be determined based on a sensor signal indicative of a closure parameter. Sensors may be tissue contact or pressure sensors, force sensors, motor current sensors, position sensors, load sensors, or other suitable sensors such as sensors 472, 474, 476, 630, 734, 736, 738, 744a-744e, 784, 788, 152408, 153102, 153112, 153118, 153126, 153200, 153438, 153448, 153450a, 153450b, 153474, described above. For the sake of clarity, sensor 474 is referenced. The sensor 474 is configured to transmit a sensor signal indicative of a parameter of the surgical instrument 112. Some types of perioperative information may be stored in the cloud 104 prior to determining tissue type and characteristics. For example, patient EMRs can be stored in the memory of the cloud 104 (e.g. cloud databases). In general, surgical instruments 112, hubs 106, or the cloud 104 can analyze perioperative information to determine tissue type and characteristics for situational awareness.
Accordingly, tissue type and characteristics determined based on perioperative information may be used to proactively adjust closure rate and maximum threshold used. That is, perioperative information may be used to predict more effective closure parameters (e.g., end effector 702 parameters) so that the closure control program applied by the surgical instrument 112 uses a closure rate and threshold that considers the patient specific tissue characteristics and type of the tissue being treated. Consequently, using the closure rate and threshold situational awareness as described herein may advantageously enable the surgical instrument 112 to apply an adjusted closure rate and threshold without over-compressing the tissue to be treated. Over-compression may be based on the first and second jaw members of the end effector 702. First and second jaw members may be first jaw member 152002, 152152, 152154 and second jaw member 152204, 152254, 152304, respectively, for example. The first and second jaw members may also refer to anvil 716, 766 and staple cartridge 718, 768. For the sake of clarity, the first jaw member is referred to as 152002 while the second jaw member is referred to as 152204. The first and second jaw members 152002, 152004 may define an end effector 702 aperture, which is defined as the distance between the first jaw member 152002 and second jaw member 152004.
Unnecessary tissue damage or trauma from over-compression may occur when the end effector 702 aperture is unnecessarily small, for example. Reducing or preventing such over-compression may be achieved by adjustment using perioperative information and/or sensor signals from sensors 474. Also, compression applied during initial closure parameter measurements, such as based on load sensor 474 (measuring closure force) and positioned sensor 474 (measuring position of first jaw member 152002 and second jaw member 152004) may be minimized. In general, sensors 474 may be configured to measure the closure force exerted by the end effector 702 of the surgical instrument 112. In addition to proactively inferring tissue characteristics and type from perioperative information, one or more of the surgical instrument 112, hub 106 and cloud 104 may use sensed measurements from the sensors 474 (as shown in
The closure parameter situational awareness may be continually performed. Thus, the clinician or surgeon may continually use perioperative information to adjust end effector 702 closure parameters (e.g., of a closure control program) as appropriate (e.g., as the steps of a surgical procedure are performed). For example, perioperative information could be used to adjust end effector 702 closure parameters when it is determined, based on clinician history (e.g., a surgeon's routine practice), that the next step of the surgical procedure being performed involves vascular tissue. In this situation, the situationally aware surgical instrument 112 may apply closure force with a constant closure rate of change. Such perioperative information may be used in conjunction with a sensor signal indicative of a closure parameter of the surgical instrument 112 to adjust end effector 702 closure parameters (e.g., closure rate of change and closure threshold of a control program). The perioperative information, such as intraoperative information, could indicate that the patient has previously been treated by radiation therapy.
Based on this information, the control circuit 500 may infer increased tissue stiffness, which is a tissue characteristic that can be considered throughout the steps of the surgical procedure. In one example, this increased tissue stiffness may be perioperative information used to supplement a sensor signal indicative of tissue thickness so that adjustment to a more appropriate end effector 702 closure parameter value may be achieved. The perioperative information may also indicate that the surgical procedure being applied is a lobectomy procedure, which could be determined from data stored in the cloud 104. Based on the knowledge of the lobectomy procedure, it may be determined that the possible tissue types to be treated (e.g., stapled) include blood vessels, bronchus tissue, and parenchyma tissue.
Accordingly, based on perioperative information, the specific tissue type and characteristics of the tissue currently being treated by the surgical instrument 112 may be predicted or inferred prior to beginning therapeutic treatment of tissue. For example, considering initial tissue thickness (measured when the tissue currently being treated first contacts the end effector 702) in conjunction with treatment, diagnosis, and patient information may enable an inference that previously irradiated parenchyma tissue is being treated. Because the type and characteristics of the tissue being treated can be contextually determined prior to commencing the surgical procedure, the closure control program implemented by the control circuit 500 of the surgical instrument 112 can be advantageously adjusted (e.g., by changing input parameters according to inferred tissue type or characteristics) or altered (e.g., by selecting a different control program) before therapeutic treatment begins. Specifically, the maximum tissue closure threshold may be decreased to address the stiffness and fragility of the irradiated parenchyma being treated. The maximum threshold could refer to a maximum closure force that may be applied or a maximum closure rate of change. Moreover, the closure algorithm of the closure control program could also be adjusted to apply a slower, more conservative closure rate based on identifying the irradiated parenchyma.
Also, it can be determined whether the surgical instrument 112 is an appropriate stapling surgical instrument 112 for the irradiated parenchyma, for example. If the perioperative information indicates that selected surgical instrument 112 is not suitable for its intended use, a warning may be generated. For example, if it can be inferred based on perioperative information that tissue currently being treated is bronchus tissue and an unsuitable vascular stapling surgical instrument 112 is selected, a warning would be generated to the clinician. In general, the surgical instrument 112 may generate an alert based on a determined, predicted or inferred inconsistency between the surgical instrument type, perioperative information, and the sensor signal. Furthermore, as discussed above, intraoperative information could also be used for adjustments during the overall surgical procedure. For example, the current step in an overall procedure operation could be treating stiff bronchus tissue, which would typically result in a slower closure rate. Further adjustments can also be made subsequent to an initial adjustment. Specifically, further adjustments could be made during operation, such as to adjust the slower closure rate to a faster closure rate when additional intraoperative information (e.g., sensed information) is analyzed and it is inferred that the force to close applied in the currently applied closure algorithm should be modified or adjusted. Such adjustments could also be made postoperatively in certain circumstances.
Therefore, closure rate and thresholds may be beneficially adjusted based on determined tissue type, tissue characteristics, and perioperative information prior to the commencement of or during therapeutic treatment. Accordingly, this adjustment may advantageously avoid or minimize tissue damage resulting from excessive strain and facilitate the proper formation of staples from a stapling surgical instrument 112.
Other more conservative thresholds than the default FTCd 22006 are also shown on graphs 22000, 22100. However, less conservative thresholds could also be used. As represented by FTCL1 22008 and FTCL2 22010, the more conservative closure thresholds are employable to reduce closure force of the surgical instrument relative to the default closure force function. FTCL1 22008 and FTCL2 22010 could be thresholds that are stored in a memory of the surgical instrument 112, hub 106, or cloud 104. Additionally or alternatively, FTCd 22006 could be dynamically adjusted at a suitable point during the surgical cycle. The dynamic adjustment could be performed by the control circuit 500, the corresponding hub 106, or the cloud 104. Also, the graphs 22000, 22100 indicate the corresponding slopes of the different closure threshold functions FTCd, FTCL1 and FTCL2 22006, 22008, 22010. Because the closure thresholds may change as a function of time in the corresponding surgical cycle, the slope of a closure threshold can be constant throughout or change as appropriate during the surgical cycle.
In other words, the instantaneous rate of change defined by the particular closure threshold function may be different between different ranges of time in the surgical cycle. For example, the particular closure threshold function may define a relatively slower rate of increase around the beginning of the surgical cycle and a relatively faster rate of increase around the middle of the surgical cycle. Closure threshold functions ΔFTCd, ΔFTCL1 and ΔFTCL2 22106, 22108, 22110 are zoomed in views of functions FTCd, FTCL1 and FTCL2 22006, 22008, 22010 and illustrate the corresponding slopes of the closure threshold functions. In the aspect of
In one aspect, a motor such as motor 482, 704a-704e, 754, 150082, 150714 of the surgical instrument 112 may move the first jaw member 152002 relative to the second jaw member 152004 of the end effector 702. For the sake of clarity, motor 482 is referenced. Motor 482 may move or close end effector 702 in accordance with the closure rate of change as represented by lines 22012, 22112 and with the selected closure threshold. To this end, the control circuit 500 may adjust a current drawn by the motor 482 to change the speed or torque of the motor 482 based on the selected threshold. For example, the graphs 22000, 22100 illustrate how the control circuit 500 may adjust the motor 482 at point “x” (as denoted on the graphs) such that the closure rate of change parameter of the surgical instrument 112 is changed to stay within the selected threshold FTCL2 22010. FTCL2 22010, which may be a patient specific threshold, may be selected and determined based on perioperative information.
The FTC thresholds 22006, 22008, 22010 depicted in graphs 22000, 22100 may be parameters of different or the same closure control programs executed by the control circuit 500. These closure control programs may be stored locally on the memory of the surgical instrument 112 or stored remotely on the hub 106 or cloud 104. In general, closure threshold functions define how closure thresholds change as a function of time in a cycle such that the instantaneously applicable closure threshold is indicated for any point of time during the cycle. Closure thresholds can define a maximum closure force that may be applied to close the end effector jaws or a maximum rate of change of closure force used, for example.
As illustrated by line 22012, the force applied increases over time from time zero to time t1, after which the rate of increase slows to zero and then to a rate of decreasing force. Shortly before time t2, the rate of decrease is much steeper. After time t2, the applied force to close the jaws begins to transition to a zero rate before again decreasing at a nonzero rate. As illustrated by line 22112 of graph 22100, the applied closure force to close the jaws 152002, 152004 is increasing between time zero to a time slightly before 0.5 seconds (shown on x-axis 22104). At the time corresponding to “x” on graph 22100, the control circuit 500 may adjust the motor 482 to adjust the selected closure algorithm such that rate of increase of the closure is decreased. In this way, the motor 482 can be controlled by the control circuit 500 to stay within the selected patient specific threshold ΔFTCL2 22110. In addition, as shown in graph 22100, after the time corresponding to “x,” the slower rate of increase of applied closure force becomes a constant rate.
In one aspect, the same overall amount of applied FTC may be applied during a surgical cycle. However, the force applied to close the end effector may be applied more gradually or immediately as appropriate. This is illustrated by the rate of change represented by closure rate of change lines such as lines 22012, 22112. Although
As discussed above, it is possible for the slope of a closure threshold function to change during one surgical cycle. In such circumstances, the dynamic slope can be adjusted consistently or individually across the entire surgical cycle. In general, a closure threshold parameter adjustment could be achieved by changing the parameter of the current closure control program (e.g., by the control circuit 500 directly altering a closure threshold function being implemented by the control circuit 500) or switching to a new closure control program altogether. The switching or adjusting could be performed by the control circuit 500, hub 106, or cloud 104 based on perioperative information. For example, the control circuit 500 may switch from the current control program to a second closure control program received from the cloud 104. The second closure control program could also be transmitted from the cloud 104 to the hub 106.
As discussed above, one or more of the surgical instrument 112 used to treat tissue, the corresponding hub 106, and the cloud 104 may be used to receive, infer, or determine perioperative information in order to determine, infer, or predict the type and characteristics of the tissue currently being therapeutically treated. These closure situational awareness inferences and predictions are useful for adjusting closure rate of change thresholds. Accordingly, in addition to FTCd, ΔFTCd 22006, 22106, graphs 22000, 21000 show, for example, a second tissue closure rate of change threshold function FTCL1, ΔFTCL1 22008, 22108, which the closure algorithm used by the surgical instrument 112 can automatically incorporate. That is, the surgical instrument 112 can adjust the inputs to the current closure control program or adjust to a different control program to be executed by the control circuit 500. For example, the situationally aware surgical hub 106 could determine that the currently applied surgical procedure is a lung surgical procedure based on the targeted area being in the thoracic cavity. In turn, the thoracic cavity could be inferred as the targeted area based on ventilation output from another device used in the surgical theater, for example. Thus, it is determined that the treated tissue type is lung tissue. Accordingly, the surgical instrument 112 can adjust to using the default closure threshold function FTCL1 22008, 22108 for lung tissue from the threshold FTCd 22006, 22106, that was previously used. Such adjustments may be made during the surgical cycle spanning the y-axis 22004, 22104.
For example, the situationally aware surgical hub 106 may predict that the patient's lung will comprise relatively brittle tissue. Consequently, a closure threshold function could be adjusted to a lower FTC threshold function, as depicted in
In addition to confirming the initial prediction, perioperative information could also be used to adapt from an inaccurate initial prediction. For example, the surgical instrument 112 could be applying a suboptimal closure algorithm based on an erroneous assumption that the tissue has more pliability than it actually has. In this situation, the patient history preoperative information may be used as part of a correction to the erroneous assumption. In general, perioperative information may be used in conjunction with sensor signals indicative of a closure parameter. Advantageously, the perioperative information could confirm an initial closure algorithm determined based on the sensor signals or could be used to adjust the initial closure algorithm to a different, more suitable closure algorithm. For example, the sensor signal could be indicative of the relationship between sensed applied closure force and end effector 702 aperture position (e.g., position of the first jaw 152002 relative to the second jaw 152004). Such a signal could be used to determine tissue stiffness and could be used in conjunction with other perioperative information to adjust the closure algorithm before or during the surgical operation.
Accordingly, the graphs 22000, 22100 of
Although
Additionally or alternatively, closure adjustment may comprise merely adjusting the inputs to a closure threshold function. For example, if a tissue characteristic such as tissue thickness is an input to a closure threshold function, perioperative information may be used to predictively or inferentially modify the inputs so that the output closure thresholds are modified according to the predicted or inferred tissue thickness input. As such, the applied closure threshold function can be modified based on perioperative information. As discussed above, the applied closure threshold function is defined by the applied closure control algorithm. Also, the applied FTC or closure force lines 22012, 22112 can be adjusted based on perioperative information.
In one aspect, the FTC or closure force lines 22012, 22112 represent a closure rate of change parameter of the corresponding closure control program executed by the control circuit 500. The FTC line 22012, 22112 is also defined by the applied closure control algorithm. In one aspect, the applied closure force can be dynamically adjusted during the cycle of a surgical procedure being performed, as indicated by the “x” in
In general, adjustment to different closure thresholds or different closure threshold functions may be performed based on a determined, inferred, or predicted characteristic or type of the tissue being treated. As discussed above, the tissue characteristics or type can be determined, inferred, or predicted based on perioperative information. Adjustment to another closure threshold may be understood as adjusting a maximum threshold with respect to a maximum torque generated by the motor 482 of the surgical instrument 112 or a rate of change of the motor speed. Various instances of perioperative information may be used to determine, infer, or predict tissue type or tissue characteristics. For example, the amount of water, the muscular properties, and the vasculature of tissue can influence the closure rate algorithm (including the closure threshold) that would be applied. In one aspect, these properties as well as other tissue type and tissue characteristic properties are used to determine the default closure threshold FTCD 22006 or any other initial closure control program parameter.
Thus, high vasculature might be a tissue characteristic used to infer a default closure threshold function with relatively low slope. Additionally to determining initial control program parameters, if preoperative information such as the surgical procedure being applied and the surgical history (e.g., the typical routine of the clinician performing the procedure with respect to surgical steps of the procedure) can be used to infer that a vascular tissue with high hemoglobin content is being targeted, then the closure rate of change applied by the surgical instrument may be adjusted to be slower. As such, these properties can be used to determine control program parameters preoperatively and intraoperatively. Also, perioperative information could be used to confirm that a suitable vascular stapler is being used for the procedure on the vascular tissue.
For example, the undeformed initial tissue thickness as measured by tissue contact sensors 474 may be used to determine an initial closure algorithm. Preoperative information such as a patient history of lung issues might be used to determine that the current surgical procedure being performed is a thoracic procedure and the tissue type is a lung tissue. This preoperative information may further be used to determine an adjustment to the initial closure algorithm. Additionally or alternatively, an initial tissue stiffness measured via comparing a non-therapeutic (or quasi non-therapeutic) initial tissue compression measurement and a closure member position measurement (e.g., position of first and second jaws of end effector) could also be used in conjunction with the preoperative information. Ventilation preoperative information received from a ventilation device in the surgical theater could further be used to infer that the current procedure is thoracic. Other preoperative information could also be used to further predict the specific thoracic procedure being performed. For example, based on the patient EMR record in the cloud indicating that the patient has cancer, it could be inferred at step 22206 that the thoracic procedure is a pulmonary lobectomy to excise cancerous tissue in a lung lobe.
Moreover, the patient EMR record could further indicate that the patient history indicates the patient has previously undergone radiation treatments for the cancer. In this situation, it may be inferred or predicted that the irradiated lung tissue would be stiff, but also susceptible to the application of monopolar RF energy by the surgical instrument 112, for example. This would be one example of an inferred tissue characteristic. Also, the inference that a pulmonary lobectomy is being performed may also be used to determine that possible tissues for stapling by the surgical instrument 112 include blood vessels (PA/PV), bronchus, and parenchyma. At step 22208, adjustments to the current closure algorithm are determined based on the preoperative information and applied. As discussed above, the closure threshold and applied FTC may be adjusted based on the tissue type and tissue characteristics. For example, high tissue stiffness may necessitate a slower more conservative rate of change of applied FTC (e.g., as represented by FTC lines 22012, 22112) as well as a closure threshold that generally outputs a lower maximum threshold (e.g., as represented by FTCL2 22010 and ΔFTCL2 22110).
The maximum threshold may indicate the threshold at which the first and second jaw members 152002, 152004 are in a sufficient position for the surgical instrument 112 to fire staples. A relatively thicker tissue may correspond to a slower closure force rate of change and also a generally higher maximum closure threshold, for example. Also, tissue type or structure could be inferred based on the determined surgical procedure and clinician history for identifying other closure algorithm adjustments at step 22208. For example, the treating surgeon's clinician history may indicate a practice of treating blood vessels first. It could be inferred that the tissue type and structure is vascular lung tissue with high blood content (i.e., high vasculature). Based on this inferred tissue type and characteristic information, it could be determined that adjustment to a slower applied FTC rate of change would be beneficial. In sum, adjustments to the current closure algorithm are determined based on the inferred information and applied at step 22208. Accordingly, the current surgical operation may be performed with the surgical instrument 112 using the adjusted current closure algorithm.
The flow diagram 22200 then proceeds to decision operation 22210, at which it is determined whether any steps of the identified surgical procedure are remaining. If there are no steps remaining (i.e., the answer to decision operation 22210 is no), the flow diagram 22200, in some aspects, terminates. However, if the answer to decision operation 22210 is yes, there are further steps of the surgical procedure remaining. Therefore, the current state of the flow diagram 22200 is intra-operation. In this case, the flow diagram proceeds to step 22212, where intraoperative information may be received and analyzed. For example, intraoperative information could indicate that the tissue type treated during this step of the surgical procedure is parenchyma. In particular, it could be inferred that the tissue is parenchyma based on clinician history, for example. This inference could be made in conjunction with tissue contact sensor 474 measurements and load sensor 474 versus closure member position measurements. Moreover, clinician history may indicate that the treating surgeon routinely completes a lung fissure (a double-fold of visceral pleura that folds inward to sheath lung parenchyma) after dissection with a monopolar RF energy surgical instrument. In this situation, it may be inferred based on the previously completed monopolar RF dissection that the current step of the surgical procedure is lung parenchyma tissue.
Additionally, the surgical hub 106 may determine whether the surgical instrument 112 being used is an appropriate stapler for parenchyma firings, for example. The initial tissue contact sensor 474 measurements may indicate that the tissue is relatively thick, such as based on tissue contacting the length of the first and second jaw members 152002, 152004 when the end effector 702 is fully open (at the maximum jaw aperture), which may be consistent with parenchyma. Furthermore, the load sensor 474 versus closure member position measurements as represented by a closure compared to jaw aperture curve may indicate relatively high tissue stiffness. This stiffness characteristic could be consistent with irradiated parenchyma, which is a prediction that could be confirmed by reference to patient EMR data in the cloud. In this way for example at step 22212, sensor signals and perioperative information could be used in conjunction.
Based on this received and analyzed intraoperative information, it may be determined at decision operation 22214, that further adjustment is necessary. On the other hand, if the answer is no at decision operation 22214, the flow diagram would proceed back to decision operation 22210. When the answer at decision operation 22214 is yes, tissue type and tissue characteristics are inferred such as determining parenchyma tissue structure and stiffness characteristics, similar to as described above at step 22206. Subsequently, adjustments to the currently applied closure algorithm can be determined and applied at step 22208. In particular, the inference that stiff and fragile parenchyma tissue is being treated could cause adjustment to a slower, more conservative rate of change of applied closure force.
Accordingly, the current closure algorithm may be adjusted to an algorithm that minimizes the closure threshold and rate of change. That is, the adjusted threshold may have a reduced maximum closure force threshold, a more gradual rate of change in closure force, a reduced rate of change of closure force threshold, or some combination or subcombination of the above. In situations in which the clinician inadvertently exceeds the closure threshold, a wait time can be instituted, for example. Exceeding the closure threshold may indicate that the tissue or material being compressed is too thick for firing staples, for example, so this wait time may be necessary. Thus, the wait time may enable some tissue material or fluid in the end effector 702 to evacuate or egress. Upon a suitable wait time, it is determined that the tissue can be properly compressed to achieve a proper end effector 702 configuration such that the stapling surgical instrument 112 can fire staples. Because the adjusted closure algorithm is more conservative, a long wait time may be used. However, the clinician may be able to override this long wait time or conservative adjusted closure algorithm by manually selecting a faster clamp protocol usage on the surgical instrument 112.
Upon applying this modified closure algorithm to the parenchyma tissue at step 22208, the flow diagram again proceeds to decision operation 22210. Here, the answer may again be yes because there are remaining steps of the surgical procedure. For example, the lobectomy procedure may then proceed to a vessel stapling step. Again, at step 22212, intraoperative information is received and analyzed. For example, the surgical hub could determine that the clinician has selected a vascular stapler surgical instrument. Also, an initial measurement from the tissue contact sensors 474 may indicate that tissue contact occurs almost immediately during closure. In addition, the tissue contact may be determined to encompass a small area of the vascular stapler 112 and is bounded on the distal side of the stapler 112. Load sensor 474 measurements may also indicate a compliant tissue structure. Further, it may be inferred that the tissue may have relatively low stiffness which may be consistent with a lung pulmonary vessel. Moreover, clinician history may indicate that the treating surgeon generally uses a vascular stapler 112 for blood vessels as the step subsequent to completing the lung fissure. Thus, intraoperative information, in conjunction with closure parameter sensor signals for example, may be used to infer tissue type and tissue characteristics. In particular, it can be predicted that vessel tissue is being treated based on the specific characteristics of the selected vascular stapler 112. The initial tissue contact and load sensor 474 measurements may confirm this initial prediction, for example.
Consequently, it can be determined at decision operation 22214 that further adjustment is necessary, which causes the flow diagram 22200 to proceed to step 22206. At step 22206, it may be inferred that the tissue is blood vessel tissue with relatively low tissue thickness and stiffness. Accordingly, the flow diagram 22200 proceeds to step 22208, where the previously applied conservative closure algorithm is adjusted to a normal closure algorithm. A normal closure algorithm may comprise a constant closure rate of change. Also, the closure threshold could be higher than the threshold used in the control algorithm for the parenchyma tissue. In other words, the normal closure algorithm may reach a higher maximum applied closure force and the closure rate of change may be faster than for parenchyma tissue. The surgical instrument can also inform the clinician of the adjustment to the normal closure algorithm via a suitable indicator, such as a light emitting diode (LED) indicator displaying a particular color. In another example, it could be determined at step 22206 that the patient has a complete lung fissure. Accordingly, there would not have been any staple firings of parenchyma tissue performed yet in the surgical procedure. In response to this determination, the surgical instrument may prompt the clinician for confirmation that this inference is correct, such as via a display of the surgical instrument. The clinician could then manually select an appropriate closure control algorithm for this step or stage of the surgical procedure. Additionally or alternatively, the surgical instrument 112 may default to a conservative closure algorithm because the inferences performed at step 22206 may not be definitive. In any case, the adjusted closure algorithm is applied at step 22208.
Continuing the description of the lung lobectomy procedure example, the flow diagram proceeds to decision operation 22210. At decision operation 22210, it may be determined that there are remaining steps of the surgical procedure. Accordingly, at step 22212, intraoperative information is received and analyzed. Based on intraoperative information, it may be inferred that the tissue type being treated is bronchus tissue. Furthermore, the initial tissue contact sensor 474 measurements could indicate that the tissue grasped between the end effector 702 contacts the first and second jaw members 152002, 152004 almost immediately during initial closure of the end effector 702 and that such contact corresponds to a small area of the stapling surgical instrument 112. Also, such contact is bounded on both sides of the jaw members 152002, 152004.
Consequently, it may be predicted that this tissue contact scenario corresponds to bronchus tissue. As discussed above, these initial tissue contact sensor 474 measurements may be non-therapeutic or quasi non-therapeutic. Furthermore, the closure load sensor 474 measurements as represented by a closure compared to jaw aperture curve may indicate a stiff tissue structure that is consistent with bronchus tissue. The indication by the surgical procedure history that a vascular stapler 112 has already been used in the surgical procedure may also mean it is likely that parenchyma staple firings have already been performed and significant monopolar RF energy usage has occurred. This surgical procedure history considered in conjunction with clinician history, for example, may be used to predict that the surgeon is treating bronchus tissue. This prediction would be consistent with the surgeon's routine practice of stapling the bronchus as the last step in a lobectomy procedure. Based on analyzing this type of and other suitable intraoperative information at step 22212, it can be determined at decision operation 22214 that further adjustment is necessary. Because the answer to decision operation 22214 is yes, the flow diagram proceeds to step 22206 where it is inferred that the treated tissue is bronchus tissue with a normal tissue stiffness and thickness.
In one aspect, it may be easy to conclude that the treated tissue is bronchus tissue because the surgical instrument 112 is only configured for a specific tissue type. For example, the surgical instrument 112 may only be adaptable to fire staples that are used for bronchus. Conversely, the surgical instrument 112 might only be adaptable to fire staples that are used for parenchyma tissue. In that scenario, a warning might be generated by the surgical instrument 112 because the surgeon is attempting to treat bronchus tissue with staples exclusively used for parenchyma tissue. This warning could be an auditory, visual, or some other appropriate warning. In another example, a warning may be provided by a vascular stapler 112 if the vascular stapler 112 is selected for use with bronchus tissue. As discussed above, it may be determined based on perioperative information that the tissue being treated is bronchus tissue that the vascular stapler is contraindicated for. Similarly, other perioperative information such as closure loads and stapler cartridge selection may be used to provide warnings when surgical instruments 112 are used for tissue types or characteristics that they are not compatible with. As discussed above, inferences made using perioperative information may be made in conjunction with closure parameter sensor signals. In all situations, safety checks may be implemented to ensure that the surgical instrument 112 being used is safe for the tissue being treated.
In accordance with the inferred tissue type and characteristics, at step 22208, an adjustment to the current closure algorithm is made. Although it may be determined that a constant closure rate is suitable, the closure rate may be adjusted to be faster or slower depending on the inferred tissue characteristics of the bronchus, for example. The closure threshold could be modified in the same or similar way. Moreover, the current closure algorithm may also be adjusted such that if and when the surgical instrument 112 exceeds the instantaneously applicable closure threshold, a longer wait time is automatically enabled or suggested. For example, this wait time for bronchus tissue may be longer than the wait time used for parenchyma tissue. As discussed above, the surgeon is informed of the selected adjustment to the closure algorithm via the LED indicators, for example. A clinician override to the longer wait time is also possible so that the surgeon may be permitted to fire the stapler surgical instrument 112 in appropriate circumstances. The flow diagram 22200 then proceeds to step 22212, where it may be determined that no further steps of the surgical procedure remain.
In one aspect, the flow diagram 22200 may be implemented by the control circuit. However, in other aspects, the flow diagram 22200 can be implemented by the surgical hub 106 or cloud 104. Additionally, although steps 22204 and 22212 are described in terms of preoperative information and intraoperative information respectively, they are not limited in this way. Specifically, perioperative information in general may be received and analyzed rather than specific preoperative or intraoperative information. As discussed above, perioperative information encompasses preoperative, intraoperative, and postoperative information. Moreover, sensor signals may be used in conjunction with perioperative information for contextual and inferential closure algorithm adjustments.
Various aspects of the subject matter described herein under the heading “SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PREOPERATIVE INFORMATION” are set out in the following examples:
A surgical system comprises a surgical instrument. The surgical instrument comprises an end effector comprising a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The surgical instrument further comprises a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter. The surgical instrument further comprises a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical system further comprises a control circuit communicatively coupled to the sensor. The control circuit is configured to receive perioperative information, wherein the perioperative information comprises one or more of a perioperative disease, a perioperative treatment, and a type of a surgical procedure. The control circuit is further configured to receive the sensor signal from the sensor and determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.
The surgical system of Example 1, wherein the control circuit is further configured to determine a characteristic of a tissue to be treated by the surgical instrument based on one or more of the perioperative information and the sensor signal.
The surgical system of Example 2, wherein the tissue characteristic comprises one or more of a tissue type characteristic, muscular characteristic, vasculature characteristic, water content characteristic, stiffness characteristic, and thickness characteristic.
The surgical system of Example 1, 2, or 3, wherein the control circuit is further configured to change a speed of the motor based on the determined adjustment to the closure rate of change parameter and closure threshold parameter.
The surgical system of Example 1, 2, 3, or 4, wherein the control circuit is further configured to generate an alert based on an inconsistency between a type of the surgical instrument and one or more of the perioperative information and the sensor signal.
The surgical system of Example 1, 2, 3, 4, or 5, wherein the perioperative information further comprises one or more of a type of a tissue to be treated by the surgical instrument, a tissue characteristic, a clinician history, and a type of staple cartridge for use with the surgical instrument.
The surgical system of Example 1, 2, 3, 4, 5, or 6, wherein the closure threshold parameter is a maximum closure force threshold and the control circuit is further configured to disable the motor for a predetermined period of time based on reaching the maximum closure force threshold.
A surgical system comprises a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system. The surgical hub is communicatively coupled to the cloud computing system. The surgical system further comprises a surgical instrument communicatively coupled to the surgical hub. The surgical instrument comprises an end effector comprising a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The end effector further comprises a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a closure control program received from the surgical hub. The end effector further comprises a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical hub is further configured to receive the sensor signal from the sensor and determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.
The surgical system of Example 8, wherein the closure control program is a first closure control program, the surgical hub is further configured to transmit a second closure control program to the surgical instrument, and the second closure control program defines the adjustment to the closure rate of change parameter and the adjustment to the closure threshold parameter.
The surgical system of Example 9, wherein the cloud computing system is configured to transmit the second closure control program to the surgical hub, and the adjustment to the closure rate of change parameter and the adjustment to the closure threshold parameter of the second control program is adjusted based on perioperative information.
The surgical system of Example 8, 9, or 10, wherein the surgical instrument is configured to generate an alert based on an inconsistency between a type of the surgical instrument and one or more of the perioperative information and the sensor signal.
The surgical system of Example 8, 9, 10, or 11, wherein the closure threshold parameter is a maximum closure force threshold, and the surgical hub is further configured to disable the motor for a predetermined period of time based on reaching the maximum closure force threshold.
The surgical system of Example 8, 9, 10, 11, or 12, wherein the perioperative information comprises one or more of a perioperative disease, a perioperative treatment, a type of a surgical procedure, a clinician history, a type of the surgical instrument, a type of a tissue being treated by the surgical instrument, and a characteristic of the tissue.
The surgical system of Example 9, wherein the surgical hub is further configured to change a speed of the motor based on the determined adjustment to the closure rate of change parameter and closure threshold parameter.
A surgical instrument comprises an end effector comprising a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The surgical instrument further comprises a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a first closure control program received from a surgical hub. The surgical instrument further comprises a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector and a control circuit communicatively coupled to the sensor and the motor. The control circuit is configured to receive the sensor signal from the sensor and determine an adjustment to the closure rate of change parameter and the closure threshold parameter based on perioperative information and the sensor signal.
The surgical system of Example 15, wherein the surgical instrument is configured to generate an alert based on an inconsistency between a type of the surgical instrument and one or more of the perioperative information and the sensor signal.
The surgical system of Example 15 or 16, wherein the control circuit is further configured to switch from the first closure control program to a second closure control program received from a cloud computing system and change a speed of the motor based on the second closure control program.
The surgical system of Example 15, 16, or 17, wherein the control circuit is further configured to determine a characteristic and a type of a tissue to be treated by the surgical instrument based on one or more of the perioperative information and the sensor signal.
The surgical system of Example 15, 16, 17, or 18, wherein the closure threshold parameter is a maximum closure force threshold.
The surgical system of Example 19, wherein the closure threshold parameter is a maximum closure force threshold.
In various aspects, the sensors of a sensor array, in accordance with the present disclosure, can be placed on a staple cartridge. An adhesive mask can be embedded with the sensors at predetermined locations. In various aspects, the sensors are attached to bumps on the staple cartridge so that the sensors are positioned higher than a cartridge deck of the staple cartridge to ensure contact with the tissue. The adhesive mask could be created in bulk using screen-printing technology on a polyester substrate, for example. Conducting pads can be printed to a common location.
In various examples, in addition to detection of proximity to cancerous tissue, an end effector of the present disclosure can also be configured to target specific cancer types in specific tissues. As indicated in the journal publication to Altenberg B and Greulich K O, Genomics 84 (2004) pp. 1014-1020, which is incorporated herein by reference in its entirety, certain cancers are characterized by an overexpression of glycolysis genes while other cancers are not characterized by an overexpression of glycolysis genes. Accordingly, an end effector of the present disclosure can be equipped with a sensor array with a high specificity for cancerous tissue characterized by an overexpression of glycolysis genes such as lung cancer or liver cancer.
In various aspects, the sensor readings of a sensor array, in accordance with the present disclosure, are communicated by the surgical instrument to a surgical hub (e.g., surgical hub 106, 206) for additional analysis and/or for situational awareness.
The foregoing detailed description has set forth various forms of the devices and/or processes via the use of block diagrams, flowcharts, and/or examples. Insofar as such block diagrams, flowcharts, and/or examples contain one or more functions and/or operations, it will be understood by those within the art that each function and/or operation within such block diagrams, flowcharts, and/or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein, in whole or in part, can be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and or firmware would be well within the skill of one of skill in the art in light of this disclosure. In addition, those skilled in the art will appreciate that the mechanisms of the subject matter described herein are capable of being distributed as one or more program products in a variety of forms, and that an illustrative form of the subject matter described herein applies regardless of the particular type of signal bearing medium used to actually carry out the distribution.
Instructions used to program logic to perform various disclosed aspects can be stored within a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Furthermore, the instructions can be distributed via a network or by way of other computer readable media. Thus a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, floppy diskettes, optical disks, compact disc, read-only memory (CD-ROMs), and magneto-optical disks, read-only memory (ROMs), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory, or a tangible, machine-readable storage used in the transmission of information over the Internet via electrical, optical, acoustical or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Accordingly, the non-transitory computer-readable medium includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).
As used in any aspect herein, the term “control circuit” may refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor comprising one or more individual instruction processing cores, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic array (PLA), or field programmable gate array (FPGA)), state machine circuitry, firmware that stores instructions executed by programmable circuitry, and any combination thereof. The control circuit may, collectively or individually, be embodied as circuitry that forms part of a larger system, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system on-chip (SoC), desktop computers, laptop computers, tablet computers, servers, smart phones, etc. Accordingly, as used herein “control circuit” includes, but is not limited to, electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application specific integrated circuit, electrical circuitry forming a general purpose computing device configured by a computer program (e.g., a general purpose computer configured by a computer program which at least partially carries out processes and/or devices described herein, or a microprocessor configured by a computer program which at least partially carries out processes and/or devices described herein), electrical circuitry forming a memory device (e.g., forms of random access memory), and/or electrical circuitry forming a communications device (e.g., a modem, communications switch, or optical-electrical equipment). Those having skill in the art will recognize that the subject matter described herein may be implemented in an analog or digital fashion or some combination thereof.
As used in any aspect herein, the term “logic” may refer to an app, software, firmware and/or circuitry configured to perform any of the aforementioned operations. Software may be embodied as a software package, code, instructions, instruction sets and/or data recorded on non-transitory computer readable storage medium. Firmware may be embodied as code, instructions or instruction sets and/or data that are hard-coded (e.g., nonvolatile) in memory devices.
As used in any aspect herein, the terms “component,” “system,” “module” and the like can refer to a computer-related entity, either hardware, a combination of hardware and software, software, or software in execution.
As used in any aspect herein, an “algorithm” refers to a self-consistent sequence of steps leading to a desired result, where a “step” refers to a manipulation of physical quantities and/or logic states which may, though need not necessarily, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common usage to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.
A network may include a packet switched network. The communication devices may be capable of communicating with each other using a selected packet switched network communications protocol. One example communications protocol may include an Ethernet communications protocol which may be capable permitting communication using a Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol may comply or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) titled “IEEE 802.3 Standard”, published in December, 2008 and/or later versions of this standard. Alternatively or additionally, the communication devices may be capable of communicating with each other using an X.25 communications protocol. The X.25 communications protocol may comply or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be capable of communicating with each other using a frame relay communications protocol. The frame relay communications protocol may comply or be compatible with a standard promulgated by Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communications protocol. The ATM communications protocol may comply or be compatible with an ATM standard published by the ATM Forum titled “ATM-MPLS Network Interworking 2.0” published August 2001, and/or later versions of this standard. Of course, different and/or after-developed connection-oriented network communication protocols are equally contemplated herein.
Unless specifically stated otherwise as apparent from the foregoing disclosure, it is appreciated that, throughout the foregoing disclosure, discussions using terms such as “processing,” “computing,” “calculating,” “determining,” “displaying,” or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical (electronic) quantities within the computer system's registers and memories into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission or display devices.
One or more components may be referred to herein as “configured to,” “configurable to,” “operable/operative to,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc. Those skilled in the art will recognize that “configured to” can generally encompass active-state components and/or inactive-state components and/or standby-state components, unless context requires otherwise.
The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” refers to the portion closest to the clinician and the term “distal” refers to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
Those skilled in the art will recognize that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to claims containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should typically be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations.
The terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has” and “having”), “include” (and any form of include, such as “includes” and “including”) and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a surgical system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more elements possesses those one or more elements, but is not limited to possessing only those one or more elements. Likewise, an element of a system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features.
In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, typically means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that typically a disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms unless context dictates otherwise. For example, the phrase “A or B” will be typically understood to include the possibilities of “A” or “B” or “A and B.”
With respect to the appended claims, those skilled in the art will appreciate that recited operations therein may generally be performed in any order. Also, although various operational flow diagrams are presented in a sequence(s), it should be understood that the various operations may be performed in other orders than those which are illustrated, or may be performed concurrently. Examples of such alternate orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reverse, or other variant orderings, unless context dictates otherwise. Furthermore, terms like “responsive to,” “related to,” or other past-tense adjectives are generally not intended to exclude such variants, unless context dictates otherwise.
It is worthy to note that any reference to “one aspect,” “an aspect,” “an exemplification,” “one exemplification,” and the like means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one aspect. Thus, appearances of the phrases “in one aspect,” “in an aspect,” “in an exemplification,” and “in one exemplification” in various places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.
Any patent application, patent, non-patent publication, or other disclosure material referred to in this specification and/or listed in any Application Data Sheet is incorporated by reference herein, to the extent that the incorporated materials is not inconsistent herewith. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more forms has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more forms were chosen and described in order to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize the various forms and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope.
Shelton, IV, Frederick E., Harris, Jason L., Yates, David C.
| Patent | Priority | Assignee | Title |
| 10758310, | Dec 28 2017 | Cilag GmbH International | Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices |
| 10779818, | Oct 05 2007 | Covidien LP | Powered surgical stapling device |
| 10849697, | Dec 28 2017 | Cilag GmbH International | Cloud interface for coupled surgical devices |
| 10887158, | Jan 31 2019 | RUBRIK, INC | Alert dependency checking |
| 10892899, | Dec 28 2017 | Cilag GmbH International | Self describing data packets generated at an issuing instrument |
| 10892995, | Dec 28 2017 | Cilag GmbH International | Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs |
| 10898186, | Dec 21 2016 | Cilag GmbH International | Staple forming pocket arrangements comprising primary sidewalls and pocket sidewalls |
| 10898622, | Dec 28 2017 | Cilag GmbH International | Surgical evacuation system with a communication circuit for communication between a filter and a smoke evacuation device |
| 10905422, | Dec 21 2016 | Cilag GmbH International | Surgical instrument for use with a robotic surgical system |
| 10905423, | Sep 05 2014 | Cilag GmbH International | Smart cartridge wake up operation and data retention |
| 10905426, | Feb 14 2008 | Cilag GmbH International | Detachable motor powered surgical instrument |
| 10912559, | Aug 20 2018 | Cilag GmbH International | Reinforced deformable anvil tip for surgical stapler anvil |
| 10925605, | Feb 14 2008 | Cilag GmbH International | Surgical stapling system |
| 10932778, | Oct 10 2008 | Cilag GmbH International | Powered surgical cutting and stapling apparatus with manually retractable firing system |
| 10932806, | Oct 30 2017 | Cilag GmbH International | Reactive algorithm for surgical system |
| 10932872, | Dec 28 2017 | Cilag GmbH International | Cloud-based medical analytics for linking of local usage trends with the resource acquisition behaviors of larger data set |
| 10943454, | Dec 28 2017 | Cilag GmbH International | Detection and escalation of security responses of surgical instruments to increasing severity threats |
| 10945731, | Sep 30 2010 | Cilag GmbH International | Tissue thickness compensator comprising controlled release and expansion |
| 10952727, | Jan 10 2007 | Cilag GmbH International | Surgical instrument for assessing the state of a staple cartridge |
| 10952728, | Jan 31 2006 | Cilag GmbH International | Powered surgical instruments with firing system lockout arrangements |
| 10959725, | Jun 15 2012 | Cilag GmbH International | Articulatable surgical instrument comprising a firing drive |
| 10959727, | Dec 21 2016 | Cilag GmbH International | Articulatable surgical end effector with asymmetric shaft arrangement |
| 10959744, | Oct 30 2017 | Cilag GmbH International | Surgical dissectors and manufacturing techniques |
| 10966627, | Mar 06 2015 | Cilag GmbH International | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
| 10966791, | Dec 28 2017 | Cilag GmbH International | Cloud-based medical analytics for medical facility segmented individualization of instrument function |
| 10973520, | Mar 28 2018 | Cilag GmbH International | Surgical staple cartridge with firing member driven camming assembly that has an onboard tissue cutting feature |
| 10979281, | Jan 31 2019 | RUBRIK, INC | Adaptive alert monitoring |
| 10980534, | May 27 2011 | Cilag GmbH International | Robotically-controlled motorized surgical instrument with an end effector |
| 10980537, | Jun 20 2017 | Cilag GmbH International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
| 10980539, | Sep 30 2015 | Cilag GmbH International | Implantable adjunct comprising bonded layers |
| 10980560, | Oct 30 2017 | Cilag GmbH International | Surgical instrument systems comprising feedback mechanisms |
| 10987102, | Sep 30 2010 | Cilag GmbH International | Tissue thickness compensator comprising a plurality of layers |
| 10987178, | Dec 28 2017 | Cilag GmbH International | Surgical hub control arrangements |
| 10993713, | Nov 09 2005 | Cilag GmbH International | Surgical instruments |
| 10993773, | Aug 15 2013 | Intuitive Surgical Operations, Inc. | Instrument sterile adapter drive features |
| 10993775, | Aug 15 2013 | Intuitive Surgical Operations, Inc. | Robotic instrument driven element |
| 11000274, | Aug 23 2013 | Cilag GmbH International | Powered surgical instrument |
| 11000275, | Jan 31 2006 | Cilag GmbH International | Surgical instrument |
| 11000277, | Jan 10 2007 | Cilag GmbH International | Surgical instrument with wireless communication between control unit and remote sensor |
| 11000279, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising an articulation system ratio |
| 11013511, | Jun 22 2007 | Cilag GmbH International | Surgical stapling instrument with an articulatable end effector |
| 11013563, | Dec 28 2017 | Cilag GmbH International | Drive arrangements for robot-assisted surgical platforms |
| 11020112, | Dec 19 2017 | Cilag GmbH International | Surgical tools configured for interchangeable use with different controller interfaces |
| 11020114, | Jun 28 2017 | Cilag GmbH International | Surgical instruments with articulatable end effector with axially shortened articulation joint configurations |
| 11020115, | Feb 12 2014 | Cilag GmbH International | Deliverable surgical instrument |
| 11026678, | Sep 23 2015 | Cilag GmbH International | Surgical stapler having motor control based on an electrical parameter related to a motor current |
| 11026684, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with multiple program responses during a firing motion |
| 11026687, | Oct 30 2017 | Cilag GmbH International | Clip applier comprising clip advancing systems |
| 11026712, | Oct 30 2017 | Cilag GmbH International | Surgical instruments comprising a shifting mechanism |
| 11026713, | Oct 30 2017 | Cilag GmbH International | Surgical clip applier configured to store clips in a stored state |
| 11026751, | Dec 28 2017 | Cilag GmbH International | Display of alignment of staple cartridge to prior linear staple line |
| 11033267, | Dec 15 2017 | Cilag GmbH International | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
| 11039834, | Aug 20 2018 | Cilag GmbH International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
| 11039836, | Jan 11 2007 | Cilag GmbH International | Staple cartridge for use with a surgical stapling instrument |
| 11039837, | Jun 28 2012 | Cilag GmbH International | Firing system lockout arrangements for surgical instruments |
| 11045189, | Sep 23 2008 | Cilag GmbH International | Robotically-controlled motorized surgical instrument with an end effector |
| 11045192, | Aug 20 2018 | Cilag GmbH International | Fabricating techniques for surgical stapler anvils |
| 11045197, | Oct 30 2017 | Cilag GmbH International | Clip applier comprising a movable clip magazine |
| 11045591, | Dec 28 2017 | Cilag GmbH International | Dual in-series large and small droplet filters |
| 11051807, | Jun 28 2019 | Cilag GmbH International | Packaging assembly including a particulate trap |
| 11051810, | Apr 15 2016 | Cilag GmbH International | Modular surgical instrument with configurable operating mode |
| 11051813, | Jan 31 2006 | Cilag GmbH International | Powered surgical instruments with firing system lockout arrangements |
| 11051836, | Oct 30 2017 | Cilag GmbH International | Surgical clip applier comprising an empty clip cartridge lockout |
| 11056244, | Dec 28 2017 | Cilag GmbH International | Automated data scaling, alignment, and organizing based on predefined parameters within surgical networks |
| 11058420, | Jan 31 2006 | Cilag GmbH International | Surgical stapling apparatus comprising a lockout system |
| 11058422, | Dec 30 2015 | Cilag GmbH International | Mechanisms for compensating for battery pack failure in powered surgical instruments |
| 11058423, | Jun 28 2012 | Cilag GmbH International | Stapling system including first and second closure systems for use with a surgical robot |
| 11058424, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising an offset articulation joint |
| 11058425, | Aug 17 2015 | Cilag GmbH International | Implantable layers for a surgical instrument |
| 11058498, | Dec 28 2017 | Cilag GmbH International | Cooperative surgical actions for robot-assisted surgical platforms |
| 11069012, | Dec 28 2017 | Cilag GmbH International | Interactive surgical systems with condition handling of devices and data capabilities |
| 11071543, | Dec 15 2017 | Cilag GmbH International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
| 11071545, | Sep 05 2014 | Cilag GmbH International | Smart cartridge wake up operation and data retention |
| 11071554, | Jun 20 2017 | Cilag GmbH International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
| 11071560, | Oct 30 2017 | Cilag GmbH International | Surgical clip applier comprising adaptive control in response to a strain gauge circuit |
| 11076853, | Dec 21 2017 | Cilag GmbH International | Systems and methods of displaying a knife position during transection for a surgical instrument |
| 11076854, | Sep 05 2014 | Cilag GmbH International | Smart cartridge wake up operation and data retention |
| 11076921, | Dec 28 2017 | Cilag GmbH International | Adaptive control program updates for surgical hubs |
| 11076929, | Sep 25 2015 | Cilag GmbH International | Implantable adjunct systems for determining adjunct skew |
| 11083452, | Sep 30 2010 | Cilag GmbH International | Staple cartridge including a tissue thickness compensator |
| 11083453, | Dec 18 2014 | Cilag GmbH International | Surgical stapling system including a flexible firing actuator and lateral buckling supports |
| 11083454, | Dec 30 2015 | Cilag GmbH International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
| 11083455, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising an articulation system ratio |
| 11083456, | Jul 28 2004 | Cilag GmbH International | Articulating surgical instrument incorporating a two-piece firing mechanism |
| 11083457, | Jun 28 2012 | Cilag GmbH International | Surgical instrument system including replaceable end effectors |
| 11083458, | Aug 20 2018 | Cilag GmbH International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
| 11090045, | Aug 31 2005 | Cilag GmbH International | Staple cartridges for forming staples having differing formed staple heights |
| 11090046, | Jun 20 2017 | Cilag GmbH International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
| 11090047, | Mar 28 2018 | Cilag GmbH International | Surgical instrument comprising an adaptive control system |
| 11090048, | Dec 21 2016 | Cilag GmbH International | Method for resetting a fuse of a surgical instrument shaft |
| 11090049, | Jun 27 2017 | Cilag GmbH International | Staple forming pocket arrangements |
| 11090075, | Oct 30 2017 | Cilag GmbH International | Articulation features for surgical end effector |
| 11090124, | Aug 15 2013 | Intuitive Surgical Operations, Inc. | Instrument sterile adapter drive interface |
| 11096688, | Mar 28 2018 | Cilag GmbH International | Rotary driven firing members with different anvil and channel engagement features |
| 11096689, | Dec 21 2016 | Cilag GmbH International | Shaft assembly comprising a lockout |
| 11096693, | Dec 28 2017 | Cilag GmbH International | Adjustment of staple height of at least one row of staples based on the sensed tissue thickness or force in closing |
| 11099963, | Jan 31 2019 | RUBRIK, INC | Alert dependency discovery |
| 11100631, | Dec 28 2017 | Cilag GmbH International | Use of laser light and red-green-blue coloration to determine properties of back scattered light |
| 11103241, | Sep 23 2008 | Cilag GmbH International | Motor-driven surgical cutting instrument |
| 11103268, | Oct 30 2017 | Cilag GmbH International | Surgical clip applier comprising adaptive firing control |
| 11103269, | Jan 31 2006 | Cilag GmbH International | Motor-driven surgical cutting and fastening instrument with tactile position feedback |
| 11109858, | Aug 23 2012 | Cilag GmbH International | Surgical instrument including a display which displays the position of a firing element |
| 11109859, | Mar 06 2015 | Cilag GmbH International | Surgical instrument comprising a lockable battery housing |
| 11109860, | Jun 28 2012 | Cilag GmbH International | Surgical end effectors for use with hand-held and robotically-controlled rotary powered surgical systems |
| 11109866, | Dec 28 2017 | Cilag GmbH International | Method for circular stapler control algorithm adjustment based on situational awareness |
| 11109878, | Oct 30 2017 | Cilag GmbH International | Surgical clip applier comprising an automatic clip feeding system |
| 11114195, | Dec 28 2017 | Cilag GmbH International | Surgical instrument with a tissue marking assembly |
| 11116502, | Jul 28 2004 | Cilag GmbH International | Surgical stapling instrument incorporating a two-piece firing mechanism |
| 11123070, | Oct 30 2017 | Cilag GmbH International | Clip applier comprising a rotatable clip magazine |
| 11129611, | Mar 28 2018 | Cilag GmbH International | Surgical staplers with arrangements for maintaining a firing member thereof in a locked configuration unless a compatible cartridge has been installed therein |
| 11129613, | Dec 30 2015 | Cilag GmbH International | Surgical instruments with separable motors and motor control circuits |
| 11129615, | Feb 05 2009 | Cilag GmbH International | Surgical stapling system |
| 11129616, | May 27 2011 | Cilag GmbH International | Surgical stapling system |
| 11129636, | Oct 30 2017 | Cilag GmbH International | Surgical instruments comprising an articulation drive that provides for high articulation angles |
| 11129680, | Dec 21 2017 | Cilag GmbH International | Surgical instrument comprising a projector |
| 11133106, | Aug 23 2013 | Cilag GmbH International | Surgical instrument assembly comprising a retraction assembly |
| 11134938, | Jun 04 2007 | Cilag GmbH International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
| 11134940, | Aug 23 2013 | Cilag GmbH International | Surgical instrument including a variable speed firing member |
| 11134942, | Dec 21 2016 | Cilag GmbH International | Surgical stapling instruments and staple-forming anvils |
| 11134943, | Jan 10 2007 | Cilag GmbH International | Powered surgical instrument including a control unit and sensor |
| 11134944, | Oct 30 2017 | Cilag GmbH International | Surgical stapler knife motion controls |
| 11134947, | Aug 31 2005 | Cilag GmbH International | Fastener cartridge assembly comprising a camming sled with variable cam arrangements |
| 11135352, | Jul 28 2004 | Cilag GmbH International | End effector including a gradually releasable medical adjunct |
| 11141153, | Oct 29 2014 | Cilag GmbH International | Staple cartridges comprising driver arrangements |
| 11141154, | Jun 27 2017 | Cilag GmbH International | Surgical end effectors and anvils |
| 11141155, | Jun 28 2012 | Cilag GmbH International | Drive system for surgical tool |
| 11141156, | Jun 28 2012 | Cilag GmbH International | Surgical stapling assembly comprising flexible output shaft |
| 11141160, | Oct 30 2017 | Cilag GmbH International | Clip applier comprising a motor controller |
| 11147547, | Dec 21 2017 | Cilag GmbH International | Surgical stapler comprising storable cartridges having different staple sizes |
| 11147549, | Jun 04 2007 | Cilag GmbH International | Stapling instrument including a firing system and a closure system |
| 11147551, | Mar 25 2019 | Cilag GmbH International | Firing drive arrangements for surgical systems |
| 11147553, | Mar 25 2019 | Cilag GmbH International | Firing drive arrangements for surgical systems |
| 11147554, | Apr 18 2016 | Cilag GmbH International | Surgical instrument system comprising a magnetic lockout |
| 11147607, | Dec 28 2017 | Cilag GmbH International | Bipolar combination device that automatically adjusts pressure based on energy modality |
| 11154296, | Mar 28 2012 | Cilag GmbH International | Anvil layer attached to a proximal end of an end effector |
| 11154297, | Feb 15 2008 | Cilag GmbH International | Layer arrangements for surgical staple cartridges |
| 11154298, | Jun 04 2007 | Cilag GmbH International | Stapling system for use with a robotic surgical system |
| 11154299, | Jun 28 2012 | Cilag GmbH International | Stapling assembly comprising a firing lockout |
| 11154301, | Feb 27 2015 | Cilag GmbH International | Modular stapling assembly |
| 11160551, | Dec 21 2016 | Cilag GmbH International | Articulatable surgical stapling instruments |
| 11160553, | Dec 21 2016 | Cilag GmbH International | Surgical stapling systems |
| 11166716, | Mar 28 2018 | Cilag GmbH International | Stapling instrument comprising a deactivatable lockout |
| 11166717, | Jan 31 2006 | Cilag GmbH International | Surgical instrument with firing lockout |
| 11166720, | Jan 10 2007 | Cilag GmbH International | Surgical instrument including a control module for assessing an end effector |
| 11172927, | Aug 31 2005 | Cilag GmbH International | Staple cartridges for forming staples having differing formed staple heights |
| 11172929, | Mar 25 2019 | Cilag GmbH International | Articulation drive arrangements for surgical systems |
| 11179150, | Apr 15 2016 | Cilag GmbH International | Systems and methods for controlling a surgical stapling and cutting instrument |
| 11179151, | Dec 21 2017 | Cilag GmbH International | Surgical instrument comprising a display |
| 11179152, | Dec 21 2017 | Cilag GmbH International | Surgical instrument comprising a tissue grasping system |
| 11179153, | Aug 31 2005 | Cilag GmbH International | Staple cartridges for forming staples having differing formed staple heights |
| 11179155, | Dec 21 2016 | Cilag GmbH International | Anvil arrangements for surgical staplers |
| 11179175, | Dec 28 2017 | Cilag GmbH International | Controlling an ultrasonic surgical instrument according to tissue location |
| 11179204, | Dec 28 2017 | Cilag GmbH International | Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices |
| 11179208, | Dec 28 2017 | Cilag GmbH International | Cloud-based medical analytics for security and authentication trends and reactive measures |
| 11185325, | Oct 16 2014 | Cilag GmbH International | End effector including different tissue gaps |
| 11191539, | Dec 21 2016 | Cilag GmbH International | Shaft assembly comprising a manually-operable retraction system for use with a motorized surgical instrument system |
| 11191540, | Dec 21 2016 | Cilag GmbH International | Protective cover arrangements for a joint interface between a movable jaw and actuator shaft of a surgical instrument |
| 11191543, | Dec 21 2016 | Cilag GmbH International | Assembly comprising a lock |
| 11191545, | Apr 15 2016 | Cilag GmbH International | Staple formation detection mechanisms |
| 11197668, | Mar 28 2018 | Cilag GmbH International | Surgical stapling assembly comprising a lockout and an exterior access orifice to permit artificial unlocking of the lockout |
| 11197670, | Dec 15 2017 | Cilag GmbH International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
| 11197671, | Jun 28 2012 | Cilag GmbH International | Stapling assembly comprising a lockout |
| 11202631, | Jun 28 2012 | Cilag GmbH International | Stapling assembly comprising a firing lockout |
| 11202633, | Sep 26 2014 | Cilag GmbH International | Surgical stapling buttresses and adjunct materials |
| 11207064, | May 27 2011 | Cilag GmbH International | Automated end effector component reloading system for use with a robotic system |
| 11207065, | Aug 20 2018 | Cilag GmbH International | Method for fabricating surgical stapler anvils |
| 11207067, | Mar 28 2018 | Cilag GmbH International | Surgical stapling device with separate rotary driven closure and firing systems and firing member that engages both jaws while firing |
| 11207090, | Oct 30 2017 | Cilag GmbH International | Surgical instruments comprising a biased shifting mechanism |
| 11213293, | Feb 09 2016 | Cilag GmbH International | Articulatable surgical instruments with single articulation link arrangements |
| 11213294, | Mar 28 2018 | Cilag GmbH International | Surgical instrument comprising co-operating lockout features |
| 11213302, | Jun 20 2017 | Cilag GmbH International | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
| 11213359, | Dec 28 2017 | Cilag GmbH International | Controllers for robot-assisted surgical platforms |
| 11219453, | Mar 28 2018 | Cilag GmbH International | Surgical stapling devices with cartridge compatible closure and firing lockout arrangements |
| 11219455, | Jun 28 2019 | Cilag GmbH International | Surgical instrument including a lockout key |
| 11224423, | Mar 06 2015 | Cilag GmbH International | Smart sensors with local signal processing |
| 11224426, | Feb 12 2016 | Cilag GmbH International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
| 11224427, | Jan 31 2006 | Cilag GmbH International | Surgical stapling system including a console and retraction assembly |
| 11224428, | Dec 21 2016 | Cilag GmbH International | Surgical stapling systems |
| 11224454, | Jan 31 2006 | Cilag GmbH International | Motor-driven surgical cutting and fastening instrument with tactile position feedback |
| 11224497, | Jun 28 2019 | Cilag GmbH International | Surgical systems with multiple RFID tags |
| 11229436, | Oct 30 2017 | Cilag GmbH International | Surgical system comprising a surgical tool and a surgical hub |
| 11229437, | Jun 28 2019 | Cilag GmbH International | Method for authenticating the compatibility of a staple cartridge with a surgical instrument |
| 11234698, | Dec 19 2019 | Cilag GmbH International | Stapling system comprising a clamp lockout and a firing lockout |
| 11234756, | Dec 28 2017 | Cilag GmbH International | Powered surgical tool with predefined adjustable control algorithm for controlling end effector parameter |
| 11241229, | Oct 29 2014 | Cilag GmbH International | Staple cartridges comprising driver arrangements |
| 11241230, | Jun 28 2012 | Cilag GmbH International | Clip applier tool for use with a robotic surgical system |
| 11241235, | Jun 28 2019 | Cilag GmbH International | Method of using multiple RFID chips with a surgical assembly |
| 11246590, | Aug 31 2005 | Cilag GmbH International | Staple cartridge including staple drivers having different unfired heights |
| 11246592, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising an articulation system lockable to a frame |
| 11246616, | Jan 31 2006 | Cilag GmbH International | Motor-driven surgical cutting and fastening instrument with tactile position feedback |
| 11246618, | Mar 01 2013 | Cilag GmbH International | Surgical instrument soft stop |
| 11246678, | Jun 28 2019 | Cilag GmbH International | Surgical stapling system having a frangible RFID tag |
| 11253254, | Apr 30 2019 | Cilag GmbH International | Shaft rotation actuator on a surgical instrument |
| 11253256, | Aug 20 2018 | Cilag GmbH International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
| 11253315, | Dec 28 2017 | Cilag GmbH International | Increasing radio frequency to create pad-less monopolar loop |
| 11257589, | Dec 28 2017 | Cilag GmbH International | Real-time analysis of comprehensive cost of all instrumentation used in surgery utilizing data fluidity to track instruments through stocking and in-house processes |
| 11259799, | Mar 26 2014 | Cilag GmbH International | Interface systems for use with surgical instruments |
| 11259803, | Jun 28 2019 | Cilag GmbH International | Surgical stapling system having an information encryption protocol |
| 11259805, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising firing member supports |
| 11259806, | Mar 28 2018 | Cilag GmbH International | Surgical stapling devices with features for blocking advancement of a camming assembly of an incompatible cartridge installed therein |
| 11259807, | Feb 19 2019 | Cilag GmbH International | Staple cartridges with cam surfaces configured to engage primary and secondary portions of a lockout of a surgical stapling device |
| 11259830, | Mar 08 2018 | Cilag GmbH International | Methods for controlling temperature in ultrasonic device |
| 11266405, | Jun 27 2017 | Cilag GmbH International | Surgical anvil manufacturing methods |
| 11266406, | Mar 14 2013 | Cilag GmbH International | Control systems for surgical instruments |
| 11266409, | Apr 16 2014 | Cilag GmbH International | Fastener cartridge comprising a sled including longitudinally-staggered ramps |
| 11266410, | May 27 2011 | Cilag GmbH International | Surgical device for use with a robotic system |
| 11266468, | Dec 28 2017 | Cilag GmbH International | Cooperative utilization of data derived from secondary sources by intelligent surgical hubs |
| 11272928, | Aug 31 2005 | Cilag GmbH International | Staple cartridges for forming staples having differing formed staple heights |
| 11272931, | Feb 19 2019 | Cilag GmbH International | Dual cam cartridge based feature for unlocking a surgical stapler lockout |
| 11272938, | Jun 27 2006 | Cilag GmbH International | Surgical instrument including dedicated firing and retraction assemblies |
| 11273001, | Dec 28 2017 | Cilag GmbH International | Surgical hub and modular device response adjustment based on situational awareness |
| 11278279, | Jan 31 2006 | Cilag GmbH International | Surgical instrument assembly |
| 11278280, | Mar 28 2018 | Cilag GmbH International | Surgical instrument comprising a jaw closure lockout |
| 11278281, | Dec 28 2017 | Cilag GmbH International | Interactive surgical system |
| 11278284, | Jun 28 2012 | Cilag GmbH International | Rotary drive arrangements for surgical instruments |
| 11284891, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with multiple program responses during a firing motion |
| 11284898, | Sep 18 2014 | Cilag GmbH International | Surgical instrument including a deployable knife |
| 11284936, | Dec 28 2017 | Cilag GmbH International | Surgical instrument having a flexible electrode |
| 11284953, | Dec 19 2017 | Cilag GmbH International | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
| 11291440, | Aug 20 2018 | Cilag GmbH International | Method for operating a powered articulatable surgical instrument |
| 11291441, | Jan 10 2007 | Cilag GmbH International | Surgical instrument with wireless communication between control unit and remote sensor |
| 11291444, | Feb 19 2019 | Cilag GmbH International | Surgical stapling assembly with cartridge based retainer configured to unlock a closure lockout |
| 11291445, | Feb 19 2019 | Cilag GmbH International | Surgical staple cartridges with integral authentication keys |
| 11291447, | Dec 19 2019 | Cilag GmbH International | Stapling instrument comprising independent jaw closing and staple firing systems |
| 11291449, | Dec 24 2009 | Cilag GmbH International | Surgical cutting instrument that analyzes tissue thickness |
| 11291451, | Jun 28 2019 | Cilag GmbH International | Surgical instrument with battery compatibility verification functionality |
| 11291465, | Oct 30 2017 | Cilag GmbH International | Surgical instruments comprising a lockable end effector socket |
| 11291495, | Dec 28 2017 | Cilag GmbH International | Interruption of energy due to inadvertent capacitive coupling |
| 11291510, | Oct 30 2017 | Cilag GmbH International | Method of hub communication with surgical instrument systems |
| 11298125, | Sep 30 2010 | Cilag GmbH International | Tissue stapler having a thickness compensator |
| 11298127, | Jun 28 2019 | Cilag GmbH International | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
| 11298129, | Feb 19 2019 | Cilag GmbH International | Method for providing an authentication lockout in a surgical stapler with a replaceable cartridge |
| 11298130, | Feb 19 2019 | Cilag GmbH International | Staple cartridge retainer with frangible authentication key |
| 11298132, | Jun 28 2019 | Cilag GmbH International | Staple cartridge including a honeycomb extension |
| 11298134, | Apr 16 2014 | Cilag GmbH International | Fastener cartridge comprising non-uniform fasteners |
| 11298148, | Mar 08 2018 | Cilag GmbH International | Live time tissue classification using electrical parameters |
| 11304695, | Aug 03 2017 | Cilag GmbH International | Surgical system shaft interconnection |
| 11304696, | Dec 19 2019 | Cilag GmbH International | Surgical instrument comprising a powered articulation system |
| 11304699, | Dec 28 2017 | Cilag GmbH International | Method for adaptive control schemes for surgical network control and interaction |
| 11304720, | Dec 28 2017 | Cilag GmbH International | Activation of energy devices |
| 11304763, | Dec 28 2017 | Cilag GmbH International | Image capturing of the areas outside the abdomen to improve placement and control of a surgical device in use |
| 11308075, | Dec 28 2017 | Cilag GmbH International | Surgical network, instrument, and cloud responses based on validation of received dataset and authentication of its source and integrity |
| 11311290, | Dec 21 2017 | Cilag GmbH International | Surgical instrument comprising an end effector dampener |
| 11311292, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with detection sensors |
| 11311294, | Sep 05 2014 | Cilag GmbH International | Powered medical device including measurement of closure state of jaws |
| 11311306, | Dec 28 2017 | Cilag GmbH International | Surgical systems for detecting end effector tissue distribution irregularities |
| 11311342, | Oct 30 2017 | Cilag GmbH International | Method for communicating with surgical instrument systems |
| 11317910, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with detection sensors |
| 11317913, | Dec 21 2016 | Cilag GmbH International | Lockout arrangements for surgical end effectors and replaceable tool assemblies |
| 11317915, | Feb 19 2019 | Cilag GmbH International | Universal cartridge based key feature that unlocks multiple lockout arrangements in different surgical staplers |
| 11317917, | Apr 18 2016 | Cilag GmbH International | Surgical stapling system comprising a lockable firing assembly |
| 11317919, | Oct 30 2017 | Cilag GmbH International | Clip applier comprising a clip crimping system |
| 11317937, | Mar 08 2018 | Cilag GmbH International | Determining the state of an ultrasonic end effector |
| 11324501, | Aug 20 2018 | Cilag GmbH International | Surgical stapling devices with improved closure members |
| 11324503, | Jun 27 2017 | Cilag GmbH International | Surgical firing member arrangements |
| 11324506, | Feb 27 2015 | Cilag GmbH International | Modular stapling assembly |
| 11324557, | Dec 28 2017 | Cilag GmbH International | Surgical instrument with a sensing array |
| 11331100, | Feb 19 2019 | Cilag GmbH International | Staple cartridge retainer system with authentication keys |
| 11331101, | Feb 19 2019 | Cilag GmbH International | Deactivator element for defeating surgical stapling device lockouts |
| 11337691, | Dec 21 2017 | Cilag GmbH International | Surgical instrument configured to determine firing path |
| 11337693, | Jun 29 2007 | Cilag GmbH International | Surgical stapling instrument having a releasable buttress material |
| 11337698, | Nov 06 2014 | Cilag GmbH International | Staple cartridge comprising a releasable adjunct material |
| 11337746, | Mar 08 2018 | Cilag GmbH International | Smart blade and power pulsing |
| 11344299, | Sep 23 2015 | Cilag GmbH International | Surgical stapler having downstream current-based motor control |
| 11344303, | Feb 12 2016 | Cilag GmbH International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
| 11344326, | Mar 08 2018 | Cilag GmbH International | Smart blade technology to control blade instability |
| 11350843, | Mar 06 2015 | Cilag GmbH International | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
| 11350916, | Jan 31 2006 | Cilag GmbH International | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
| 11350928, | Apr 18 2016 | Cilag GmbH International | Surgical instrument comprising a tissue thickness lockout and speed control system |
| 11350929, | Jan 10 2007 | Cilag GmbH International | Surgical instrument with wireless communication between control unit and sensor transponders |
| 11350932, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with improved stop/start control during a firing motion |
| 11350934, | Dec 21 2016 | Cilag GmbH International | Staple forming pocket arrangement to accommodate different types of staples |
| 11350935, | Dec 21 2016 | Cilag GmbH International | Surgical tool assemblies with closure stroke reduction features |
| 11350938, | Jun 28 2019 | Cilag GmbH International | Surgical instrument comprising an aligned rfid sensor |
| 11357503, | Feb 19 2019 | Cilag GmbH International | Staple cartridge retainers with frangible retention features and methods of using same |
| 11361853, | Oct 29 2002 | Practice Velocity, LLC | Method and system for automated medical records processing with telemedicine |
| 11364027, | Dec 21 2017 | Cilag GmbH International | Surgical instrument comprising speed control |
| 11364046, | Jan 31 2006 | Cilag GmbH International | Motor-driven surgical cutting and fastening instrument with tactile position feedback |
| 11364075, | Dec 28 2017 | Cilag GmbH International | Radio frequency energy device for delivering combined electrical signals |
| 11369368, | Dec 21 2017 | Cilag GmbH International | Surgical instrument comprising synchronized drive systems |
| 11369376, | Dec 21 2016 | Cilag GmbH International | Surgical stapling systems |
| 11369377, | Jun 25 2019 | Cilag GmbH International | Surgical stapling assembly with cartridge based retainer configured to unlock a firing lockout |
| 11373755, | Aug 23 2012 | Cilag GmbH International | Surgical device drive system including a ratchet mechanism |
| 11376001, | Aug 23 2013 | Cilag GmbH International | Surgical stapling device with rotary multi-turn retraction mechanism |
| 11376002, | Dec 28 2017 | Cilag GmbH International | Surgical instrument cartridge sensor assemblies |
| 11376098, | Jun 28 2019 | Cilag GmbH International | Surgical instrument system comprising an RFID system |
| 11382625, | Apr 16 2014 | Cilag GmbH International | Fastener cartridge comprising non-uniform fasteners |
| 11382626, | Oct 03 2006 | Cilag GmbH International | Surgical system including a knife bar supported for rotational and axial travel |
| 11382627, | Apr 16 2014 | Cilag GmbH International | Surgical stapling assembly comprising a firing member including a lateral extension |
| 11382628, | Dec 10 2014 | Cilag GmbH International | Articulatable surgical instrument system |
| 11382638, | Jun 20 2017 | Cilag GmbH International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
| 11382697, | Dec 28 2017 | Cilag GmbH International | Surgical instruments comprising button circuits |
| 11389160, | Aug 23 2013 | Cilag GmbH International | Surgical system comprising a display |
| 11389161, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
| 11389162, | Sep 05 2014 | Cilag GmbH International | Smart cartridge wake up operation and data retention |
| 11389164, | Dec 28 2017 | Cilag GmbH International | Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices |
| 11389188, | Mar 08 2018 | Cilag GmbH International | Start temperature of blade |
| 11395651, | Sep 30 2010 | Cilag GmbH International | Adhesive film laminate |
| 11395652, | Apr 16 2013 | Cilag GmbH International | Powered surgical stapler |
| 11399828, | Aug 31 2005 | Cilag GmbH International | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
| 11399829, | Sep 29 2017 | Cilag GmbH International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
| 11399831, | Dec 18 2014 | Cilag GmbH International | Drive arrangements for articulatable surgical instruments |
| 11399837, | Jun 28 2019 | Cilag GmbH International | Mechanisms for motor control adjustments of a motorized surgical instrument |
| 11399858, | Mar 08 2018 | Cilag GmbH International | Application of smart blade technology |
| 11406377, | Sep 30 2010 | Cilag GmbH International | Adhesive film laminate |
| 11406378, | Mar 28 2012 | Cilag GmbH International | Staple cartridge comprising a compressible tissue thickness compensator |
| 11406380, | Sep 23 2008 | Cilag GmbH International | Motorized surgical instrument |
| 11406381, | Apr 16 2013 | Cilag GmbH International | Powered surgical stapler |
| 11406382, | Mar 28 2018 | Cilag GmbH International | Staple cartridge comprising a lockout key configured to lift a firing member |
| 11406386, | Sep 05 2014 | Cilag GmbH International | End effector including magnetic and impedance sensors |
| 11406390, | Oct 30 2017 | Cilag GmbH International | Clip applier comprising interchangeable clip reloads |
| 11413042, | Oct 30 2017 | Cilag GmbH International | Clip applier comprising a reciprocating clip advancing member |
| 11419606, | Dec 21 2016 | Cilag GmbH International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
| 11419630, | Dec 28 2017 | Cilag GmbH International | Surgical system distributed processing |
| 11419667, | Dec 28 2017 | Cilag GmbH International | Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location |
| 11423007, | Dec 28 2017 | Cilag GmbH International | Adjustment of device control programs based on stratified contextual data in addition to the data |
| 11426160, | Mar 06 2015 | Cilag GmbH International | Smart sensors with local signal processing |
| 11426167, | Jun 28 2019 | Cilag GmbH International | Mechanisms for proper anvil attachment surgical stapling head assembly |
| 11426251, | Apr 30 2019 | Cilag GmbH International | Articulation directional lights on a surgical instrument |
| 11432816, | Apr 30 2019 | Cilag GmbH International | Articulation pin for a surgical instrument |
| 11432885, | Dec 28 2017 | Cilag GmbH International | Sensing arrangements for robot-assisted surgical platforms |
| 11432894, | Nov 15 2017 | Intuitive Surgical Operations, Inc. | Surgical instrument end effector with integral FBG |
| 11439470, | May 27 2011 | Cilag GmbH International | Robotically-controlled surgical instrument with selectively articulatable end effector |
| 11446029, | Dec 19 2019 | Cilag GmbH International | Staple cartridge comprising projections extending from a curved deck surface |
| 11446034, | Feb 14 2008 | Cilag GmbH International | Surgical stapling assembly comprising first and second actuation systems configured to perform different functions |
| 11446052, | Dec 28 2017 | Cilag GmbH International | Variation of radio frequency and ultrasonic power level in cooperation with varying clamp arm pressure to achieve predefined heat flux or power applied to tissue |
| 11452526, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising a staged voltage regulation start-up system |
| 11452528, | Apr 30 2019 | Cilag GmbH International | Articulation actuators for a surgical instrument |
| 11457918, | Oct 29 2014 | Cilag GmbH International | Cartridge assemblies for surgical staplers |
| 11457944, | Mar 08 2018 | Cilag GmbH International | Adaptive advanced tissue treatment pad saver mode |
| 11464511, | Feb 19 2019 | Cilag GmbH International | Surgical staple cartridges with movable authentication key arrangements |
| 11464512, | Dec 19 2019 | Cilag GmbH International | Staple cartridge comprising a curved deck surface |
| 11464513, | Jun 28 2012 | Cilag GmbH International | Surgical instrument system including replaceable end effectors |
| 11464514, | Feb 14 2008 | Cilag GmbH International | Motorized surgical stapling system including a sensing array |
| 11464532, | Mar 08 2018 | Cilag GmbH International | Methods for estimating and controlling state of ultrasonic end effector |
| 11464535, | Dec 28 2017 | Cilag GmbH International | Detection of end effector emersion in liquid |
| 11464559, | Dec 28 2017 | Cilag GmbH International | Estimating state of ultrasonic end effector and control system therefor |
| 11464601, | Jun 28 2019 | Cilag GmbH International | Surgical instrument comprising an RFID system for tracking a movable component |
| 11471155, | Aug 03 2017 | Cilag GmbH International | Surgical system bailout |
| 11471156, | Mar 28 2018 | Cilag GmbH International | Surgical stapling devices with improved rotary driven closure systems |
| 11471157, | Apr 30 2019 | Cilag GmbH International | Articulation control mapping for a surgical instrument |
| 11478241, | Jun 28 2019 | Cilag GmbH International | Staple cartridge including projections |
| 11478242, | Jun 28 2017 | Cilag GmbH International | Jaw retainer arrangement for retaining a pivotable surgical instrument jaw in pivotable retaining engagement with a second surgical instrument jaw |
| 11478244, | Oct 31 2017 | Cilag GmbH International | Cartridge body design with force reduction based on firing completion |
| 11478247, | Jul 30 2010 | Cilag GmbH International | Tissue acquisition arrangements and methods for surgical stapling devices |
| 11484307, | Feb 14 2008 | Cilag GmbH International | Loading unit coupleable to a surgical stapling system |
| 11484309, | Dec 30 2015 | Cilag GmbH International | Surgical stapling system comprising a controller configured to cause a motor to reset a firing sequence |
| 11484310, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising a shaft including a closure tube profile |
| 11484311, | Aug 31 2005 | Cilag GmbH International | Staple cartridge comprising a staple driver arrangement |
| 11484312, | Aug 31 2005 | Cilag GmbH International | Staple cartridge comprising a staple driver arrangement |
| 11490889, | Sep 23 2015 | Cilag GmbH International | Surgical stapler having motor control based on an electrical parameter related to a motor current |
| 11497488, | Mar 26 2014 | Cilag GmbH International | Systems and methods for controlling a segmented circuit |
| 11497492, | Jun 28 2019 | Cilag GmbH International | Surgical instrument including an articulation lock |
| 11497499, | Dec 21 2016 | Cilag GmbH International | Articulatable surgical stapling instruments |
| 11504116, | Mar 28 2012 | Cilag GmbH International | Layer of material for a surgical end effector |
| 11504119, | Aug 23 2013 | Cilag GmbH International | Surgical instrument including an electronic firing lockout |
| 11504122, | Dec 19 2019 | Cilag GmbH International | Surgical instrument comprising a nested firing member |
| 11504192, | Oct 30 2014 | Cilag GmbH International | Method of hub communication with surgical instrument systems |
| 11510671, | Jun 28 2012 | Cilag GmbH International | Firing system lockout arrangements for surgical instruments |
| 11510741, | Oct 30 2017 | Cilag GmbH International | Method for producing a surgical instrument comprising a smart electrical system |
| 11517304, | Sep 23 2008 | Cilag GmbH International | Motor-driven surgical cutting instrument |
| 11517306, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with detection sensors |
| 11517309, | Feb 19 2019 | Cilag GmbH International | Staple cartridge retainer with retractable authentication key |
| 11517311, | Dec 18 2014 | Cilag GmbH International | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
| 11517315, | Apr 16 2014 | Cilag GmbH International | Fastener cartridges including extensions having different configurations |
| 11517325, | Jun 20 2017 | Cilag GmbH International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
| 11517390, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising a limited travel switch |
| 11523821, | Sep 26 2014 | Cilag GmbH International | Method for creating a flexible staple line |
| 11523822, | Jun 28 2019 | Cilag GmbH International | Battery pack including a circuit interrupter |
| 11523823, | Feb 09 2016 | Cilag GmbH International | Surgical instruments with non-symmetrical articulation arrangements |
| 11529137, | Dec 19 2019 | Cilag GmbH International | Staple cartridge comprising driver retention members |
| 11529138, | Mar 01 2013 | Cilag GmbH International | Powered surgical instrument including a rotary drive screw |
| 11529139, | Dec 19 2019 | Cilag GmbH International | Motor driven surgical instrument |
| 11529140, | Jun 28 2017 | Cilag GmbH International | Surgical instrument lockout arrangement |
| 11529142, | Oct 01 2010 | Cilag GmbH International | Surgical instrument having a power control circuit |
| 11529187, | Dec 28 2017 | Cilag GmbH International | Surgical evacuation sensor arrangements |
| 11534162, | Jun 28 2012 | Cilag GmbH International | Robotically powered surgical device with manually-actuatable reversing system |
| 11534196, | Mar 08 2018 | Cilag GmbH International | Using spectroscopy to determine device use state in combo instrument |
| 11534259, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising an articulation indicator |
| 11540829, | Jun 28 2012 | Cilag GmbH International | Surgical instrument system including replaceable end effectors |
| 11540855, | Dec 28 2017 | Cilag GmbH International | Controlling activation of an ultrasonic surgical instrument according to the presence of tissue |
| 11547403, | Dec 18 2014 | Cilag GmbH International | Surgical instrument having a laminate firing actuator and lateral buckling supports |
| 11547404, | Dec 18 2014 | Cilag GmbH International | Surgical instrument assembly comprising a flexible articulation system |
| 11553911, | Dec 18 2014 | Cilag GmbH International | Surgical instrument assembly comprising a flexible articulation system |
| 11553916, | Sep 30 2015 | Cilag GmbH International | Compressible adjunct with crossing spacer fibers |
| 11553919, | Jun 28 2019 | Cilag GmbH International | Method for authenticating the compatibility of a staple cartridge with a surgical instrument |
| 11553971, | Jun 28 2019 | Cilag GmbH International | Surgical RFID assemblies for display and communication |
| 11559302, | Jun 04 2007 | Cilag GmbH International | Surgical instrument including a firing member movable at different speeds |
| 11559303, | Apr 18 2016 | Cilag GmbH International | Cartridge lockout arrangements for rotary powered surgical cutting and stapling instruments |
| 11559304, | Dec 19 2019 | Cilag GmbH International | Surgical instrument comprising a rapid closure mechanism |
| 11559307, | Dec 28 2017 | Cilag GmbH International | Method of robotic hub communication, detection, and control |
| 11559308, | Dec 28 2017 | Cilag GmbH International | Method for smart energy device infrastructure |
| 11559496, | Sep 30 2010 | Cilag GmbH International | Tissue thickness compensator configured to redistribute compressive forces |
| 11564679, | Apr 16 2013 | Cilag GmbH International | Powered surgical stapler |
| 11564682, | Jun 04 2007 | Cilag GmbH International | Surgical stapler device |
| 11564686, | Jun 28 2017 | Cilag GmbH International | Surgical shaft assemblies with flexible interfaces |
| 11564688, | Dec 21 2016 | Cilag GmbH International | Robotic surgical tool having a retraction mechanism |
| 11564703, | Oct 30 2017 | Cilag GmbH International | Surgical suturing instrument comprising a capture width which is larger than trocar diameter |
| 11564756, | Oct 30 2017 | Cilag GmbH International | Method of hub communication with surgical instrument systems |
| 11564758, | Aug 15 2013 | Intuitive Surgical Operations, Inc. | Preloaded surgical instrument interface |
| 11571207, | Dec 18 2014 | Cilag GmbH International | Surgical system including lateral supports for a flexible drive member |
| 11571212, | Feb 14 2008 | Cilag GmbH International | Surgical stapling system including an impedance sensor |
| 11571215, | Sep 30 2010 | Cilag GmbH International | Layer of material for a surgical end effector |
| 11571231, | Sep 29 2006 | Cilag GmbH International | Staple cartridge having a driver for driving multiple staples |
| 11571234, | Dec 28 2017 | Cilag GmbH International | Temperature control of ultrasonic end effector and control system therefor |
| 11576668, | Dec 21 2017 | Cilag GmbH International | Staple instrument comprising a firing path display |
| 11576672, | Dec 19 2019 | Cilag GmbH International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
| 11576673, | Aug 31 2005 | Cilag GmbH International | Stapling assembly for forming staples to different heights |
| 11576677, | Dec 28 2017 | Cilag GmbH International | Method of hub communication, processing, display, and cloud analytics |
| 11583274, | Dec 21 2017 | Cilag GmbH International | Self-guiding stapling instrument |
| 11583277, | Sep 30 2010 | Cilag GmbH International | Layer of material for a surgical end effector |
| 11583278, | May 27 2011 | Cilag GmbH International | Surgical stapling system having multi-direction articulation |
| 11583279, | Oct 10 2008 | Cilag GmbH International | Powered surgical cutting and stapling apparatus with manually retractable firing system |
| 11589864, | Dec 13 2019 | VYAS, DINESH | Stapler apparatus and methods for use |
| 11589865, | Mar 28 2018 | Cilag GmbH International | Methods for controlling a powered surgical stapler that has separate rotary closure and firing systems |
| 11589888, | Dec 28 2017 | Cilag GmbH International | Method for controlling smart energy devices |
| 11589915, | Mar 08 2018 | Cilag GmbH International | In-the-jaw classifier based on a model |
| 11589932, | Dec 28 2017 | Cilag GmbH International | Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures |
| 11596291, | Dec 28 2017 | Cilag GmbH International | Method of compressing tissue within a stapling device and simultaneously displaying of the location of the tissue within the jaws |
| 11596406, | Apr 16 2014 | Cilag GmbH International | Fastener cartridges including extensions having different configurations |
| 11601371, | Dec 28 2017 | Cilag GmbH International | Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs |
| 11602340, | Sep 30 2010 | Cilag GmbH International | Adhesive film laminate |
| 11602346, | Jun 28 2012 | Cilag GmbH International | Robotically powered surgical device with manually-actuatable reversing system |
| 11602366, | Oct 30 2017 | Cilag GmbH International | Surgical suturing instrument configured to manipulate tissue using mechanical and electrical power |
| 11602393, | Dec 28 2017 | Cilag GmbH International | Surgical evacuation sensing and generator control |
| 11607219, | Dec 19 2019 | Cilag GmbH International | Staple cartridge comprising a detachable tissue cutting knife |
| 11607239, | Apr 15 2016 | Cilag GmbH International | Systems and methods for controlling a surgical stapling and cutting instrument |
| 11612393, | Jan 31 2006 | Cilag GmbH International | Robotically-controlled end effector |
| 11612394, | May 27 2011 | Cilag GmbH International | Automated end effector component reloading system for use with a robotic system |
| 11612395, | Feb 14 2008 | Cilag GmbH International | Surgical system including a control system having an RFID tag reader |
| 11612408, | Dec 28 2017 | Cilag GmbH International | Determining tissue composition via an ultrasonic system |
| 11612444, | Dec 28 2017 | Cilag GmbH International | Adjustment of a surgical device function based on situational awareness |
| 11617575, | Sep 23 2008 | Cilag GmbH International | Motor-driven surgical cutting instrument |
| 11617576, | Sep 23 2008 | Cilag GmbH International | Motor-driven surgical cutting instrument |
| 11617577, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
| 11617597, | Mar 08 2018 | Cilag GmbH International | Application of smart ultrasonic blade technology |
| 11622763, | Apr 16 2013 | Cilag GmbH International | Stapling assembly comprising a shiftable drive |
| 11622766, | Jun 28 2012 | Cilag GmbH International | Empty clip cartridge lockout |
| 11622785, | Sep 29 2006 | Cilag GmbH International | Surgical staples having attached drivers and stapling instruments for deploying the same |
| 11627243, | Jul 23 2021 | Phaox LLC | Handheld wireless endoscope image streaming apparatus |
| 11627959, | Jun 28 2019 | Cilag GmbH International | Surgical instruments including manual and powered system lockouts |
| 11627960, | Dec 02 2020 | Cilag GmbH International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
| 11633183, | Apr 16 2013 | Cilag International GmbH | Stapling assembly comprising a retraction drive |
| 11633237, | Dec 28 2017 | Cilag GmbH International | Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures |
| 11638581, | Apr 16 2013 | Cilag GmbH International | Powered surgical stapler |
| 11638582, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with torsion spine drive arrangements |
| 11638583, | Feb 14 2008 | Cilag GmbH International | Motorized surgical system having a plurality of power sources |
| 11638587, | Jun 28 2019 | Cilag GmbH International | RFID identification systems for surgical instruments |
| 11642125, | Apr 15 2016 | Cilag GmbH International | Robotic surgical system including a user interface and a control circuit |
| 11642128, | Jun 28 2017 | Cilag GmbH International | Method for articulating a surgical instrument |
| 11648005, | Sep 23 2008 | Cilag GmbH International | Robotically-controlled motorized surgical instrument with an end effector |
| 11648006, | Jun 04 2007 | Cilag GmbH International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
| 11648008, | Jan 31 2006 | Cilag GmbH International | Surgical instrument having force feedback capabilities |
| 11648009, | Apr 30 2019 | Cilag GmbH International | Rotatable jaw tip for a surgical instrument |
| 11648022, | Oct 30 2017 | Cilag GmbH International | Surgical instrument systems comprising battery arrangements |
| 11648024, | Jan 31 2006 | Cilag GmbH International | Motor-driven surgical cutting and fastening instrument with position feedback |
| 11653914, | Jun 20 2017 | Cilag GmbH International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
| 11653915, | Dec 02 2020 | Cilag GmbH International | Surgical instruments with sled location detection and adjustment features |
| 11653917, | Dec 21 2016 | Cilag GmbH International | Surgical stapling systems |
| 11653918, | Sep 05 2014 | Cilag GmbH International | Local display of tissue parameter stabilization |
| 11653920, | Dec 02 2020 | Cilag GmbH International | Powered surgical instruments with communication interfaces through sterile barrier |
| 11659023, | Dec 28 2017 | Cilag GmbH International | Method of hub communication |
| 11660090, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with segmented flexible drive arrangements |
| 11660110, | Jan 31 2006 | Cilag GmbH International | Motor-driven surgical cutting and fastening instrument with tactile position feedback |
| 11660163, | Jun 28 2019 | Cilag GmbH International | Surgical system with RFID tags for updating motor assembly parameters |
| 11666331, | Dec 28 2017 | Cilag GmbH International | Systems for detecting proximity of surgical end effector to cancerous tissue |
| 11666332, | Jan 10 2007 | Cilag GmbH International | Surgical instrument comprising a control circuit configured to adjust the operation of a motor |
| 11672531, | Jun 04 2007 | Cilag GmbH International | Rotary drive systems for surgical instruments |
| 11672532, | Jun 20 2017 | Cilag GmbH International | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
| 11672536, | Sep 30 2010 | Cilag GmbH International | Layer of material for a surgical end effector |
| 11678877, | Dec 18 2014 | Cilag GmbH International | Surgical instrument including a flexible support configured to support a flexible firing member |
| 11678880, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising a shaft including a housing arrangement |
| 11678881, | Dec 28 2017 | Cilag GmbH International | Spatial awareness of surgical hubs in operating rooms |
| 11678882, | Dec 02 2020 | Cilag GmbH International | Surgical instruments with interactive features to remedy incidental sled movements |
| 11678901, | Mar 08 2018 | Cilag GmbH International | Vessel sensing for adaptive advanced hemostasis |
| 11678927, | Mar 08 2018 | Cilag GmbH International | Detection of large vessels during parenchymal dissection using a smart blade |
| 11684360, | Sep 30 2010 | Cilag GmbH International | Staple cartridge comprising a variable thickness compressible portion |
| 11684361, | Sep 23 2008 | Cilag GmbH International | Motor-driven surgical cutting instrument |
| 11684365, | Jul 28 2004 | Cilag GmbH International | Replaceable staple cartridges for surgical instruments |
| 11684369, | Jun 28 2019 | Cilag GmbH International | Method of using multiple RFID chips with a surgical assembly |
| 11684434, | Jun 28 2019 | Cilag GmbH International | Surgical RFID assemblies for instrument operational setting control |
| 11690615, | Apr 16 2013 | Cilag GmbH International | Surgical system including an electric motor and a surgical instrument |
| 11690623, | Sep 30 2015 | Cilag GmbH International | Method for applying an implantable layer to a fastener cartridge |
| 11696757, | Feb 26 2021 | Cilag GmbH International | Monitoring of internal systems to detect and track cartridge motion status |
| 11696759, | Jun 28 2017 | Cilag GmbH International | Surgical stapling instruments comprising shortened staple cartridge noses |
| 11696760, | Dec 28 2017 | Cilag GmbH International | Safety systems for smart powered surgical stapling |
| 11696761, | Mar 25 2019 | Cilag GmbH International | Firing drive arrangements for surgical systems |
| 11696778, | Oct 30 2017 | Cilag GmbH International | Surgical dissectors configured to apply mechanical and electrical energy |
| 11701110, | Aug 23 2013 | Cilag GmbH International | Surgical instrument including a drive assembly movable in a non-motorized mode of operation |
| 11701111, | Dec 19 2019 | Cilag GmbH International | Method for operating a surgical stapling instrument |
| 11701113, | Feb 26 2021 | Cilag GmbH International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
| 11701114, | Oct 16 2014 | Cilag GmbH International | Staple cartridge |
| 11701115, | Dec 21 2016 | Cilag GmbH International | Methods of stapling tissue |
| 11701139, | Mar 08 2018 | Cilag GmbH International | Methods for controlling temperature in ultrasonic device |
| 11701162, | Mar 08 2018 | Cilag GmbH International | Smart blade application for reusable and disposable devices |
| 11701185, | Dec 28 2017 | Cilag GmbH International | Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices |
| 11707273, | Jun 15 2012 | Cilag GmbH International | Articulatable surgical instrument comprising a firing drive |
| 11707293, | Mar 08 2018 | Cilag GmbH International | Ultrasonic sealing algorithm with temperature control |
| 11707335, | Dec 30 2005 | Intuitive Surgical Operations, Inc. | Wireless force sensor on a distal portion of a surgical instrument and method |
| 11712244, | Sep 30 2015 | Cilag GmbH International | Implantable layer with spacer fibers |
| 11712303, | Dec 28 2017 | Cilag GmbH International | Surgical instrument comprising a control circuit |
| 11717285, | Feb 14 2008 | Cilag GmbH International | Surgical cutting and fastening instrument having RF electrodes |
| 11717289, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
| 11717291, | Mar 22 2021 | Cilag GmbH International | Staple cartridge comprising staples configured to apply different tissue compression |
| 11717294, | Apr 16 2014 | Cilag GmbH International | End effector arrangements comprising indicators |
| 11717297, | Sep 05 2014 | Cilag GmbH International | Smart cartridge wake up operation and data retention |
| 11723657, | Feb 26 2021 | Cilag GmbH International | Adjustable communication based on available bandwidth and power capacity |
| 11723658, | Mar 22 2021 | Cilag GmbH International | Staple cartridge comprising a firing lockout |
| 11723662, | May 28 2021 | Cilag GmbH International | Stapling instrument comprising an articulation control display |
| 11730471, | Feb 09 2016 | Cilag GmbH International | Articulatable surgical instruments with single articulation link arrangements |
| 11730473, | Feb 26 2021 | Cilag GmbH International | Monitoring of manufacturing life-cycle |
| 11730474, | Aug 31 2005 | Cilag GmbH International | Fastener cartridge assembly comprising a movable cartridge and a staple driver arrangement |
| 11730477, | Oct 10 2008 | Cilag GmbH International | Powered surgical system with manually retractable firing system |
| 11737668, | Dec 28 2017 | Cilag GmbH International | Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems |
| 11737748, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with double spherical articulation joints with pivotable links |
| 11737749, | Mar 22 2021 | Cilag GmbH International | Surgical stapling instrument comprising a retraction system |
| 11737751, | Dec 02 2020 | Cilag GmbH International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
| 11737754, | Sep 30 2010 | Cilag GmbH International | Surgical stapler with floating anvil |
| 11744581, | Dec 02 2020 | Cilag GmbH International | Powered surgical instruments with multi-phase tissue treatment |
| 11744583, | Feb 26 2021 | Cilag GmbH International | Distal communication array to tune frequency of RF systems |
| 11744588, | Feb 27 2015 | Cilag GmbH International | Surgical stapling instrument including a removably attachable battery pack |
| 11744593, | Jun 28 2019 | Cilag GmbH International | Method for authenticating the compatibility of a staple cartridge with a surgical instrument |
| 11744603, | Mar 24 2021 | Cilag GmbH International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
| 11744604, | Dec 28 2017 | Cilag GmbH International | Surgical instrument with a hardware-only control circuit |
| 11749877, | Feb 26 2021 | Cilag GmbH International | Stapling instrument comprising a signal antenna |
| 11751867, | Dec 21 2017 | Cilag GmbH International | Surgical instrument comprising sequenced systems |
| 11751869, | Feb 26 2021 | Cilag GmbH International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
| 11751872, | Feb 19 2019 | Cilag GmbH International | Insertable deactivator element for surgical stapler lockouts |
| 11751958, | Dec 28 2017 | Cilag GmbH International | Surgical hub coordination of control and communication of operating room devices |
| 11759202, | Mar 22 2021 | Cilag GmbH International | Staple cartridge comprising an implantable layer |
| 11759208, | Dec 30 2015 | Cilag GmbH International | Mechanisms for compensating for battery pack failure in powered surgical instruments |
| 11766258, | Jun 27 2017 | Cilag GmbH International | Surgical anvil arrangements |
| 11766259, | Dec 21 2016 | Cilag GmbH International | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
| 11766260, | Dec 21 2016 | Cilag GmbH International | Methods of stapling tissue |
| 11771419, | Jun 28 2019 | Cilag GmbH International | Packaging for a replaceable component of a surgical stapling system |
| 11771425, | Aug 31 2005 | Cilag GmbH International | Stapling assembly for forming staples to different formed heights |
| 11771426, | Jan 10 2007 | Cilag GmbH International | Surgical instrument with wireless communication |
| 11771487, | Dec 28 2017 | Cilag GmbH International | Mechanisms for controlling different electromechanical systems of an electrosurgical instrument |
| 11775682, | Dec 28 2017 | Cilag GmbH International | Data stripping method to interrogate patient records and create anonymized record |
| 11779330, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising a jaw alignment system |
| 11779336, | Feb 12 2016 | Cilag GmbH International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
| 11779337, | Dec 28 2017 | Cilag GmbH International | Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices |
| 11779420, | Jun 28 2012 | Cilag GmbH International | Robotic surgical attachments having manually-actuated retraction assemblies |
| 11786239, | Mar 24 2021 | Cilag GmbH International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
| 11786243, | Mar 24 2021 | Cilag GmbH International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
| 11786245, | Dec 28 2017 | Cilag GmbH International | Surgical systems with prioritized data transmission capabilities |
| 11786251, | Dec 28 2017 | Cilag GmbH International | Method for adaptive control schemes for surgical network control and interaction |
| 11793509, | Mar 28 2012 | Cilag GmbH International | Staple cartridge including an implantable layer |
| 11793511, | Nov 09 2005 | Cilag GmbH International | Surgical instruments |
| 11793512, | Aug 31 2005 | Cilag GmbH International | Staple cartridges for forming staples having differing formed staple heights |
| 11793513, | Jun 20 2017 | Cilag GmbH International | Systems and methods for controlling motor speed according to user input for a surgical instrument |
| 11793514, | Feb 26 2021 | Cilag GmbH International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
| 11793516, | Mar 24 2021 | Cilag GmbH International | Surgical staple cartridge comprising longitudinal support beam |
| 11793518, | Jan 31 2006 | Cilag GmbH International | Powered surgical instruments with firing system lockout arrangements |
| 11793521, | Oct 10 2008 | Cilag GmbH International | Powered surgical cutting and stapling apparatus with manually retractable firing system |
| 11793522, | Sep 30 2015 | Cilag GmbH International | Staple cartridge assembly including a compressible adjunct |
| 11793537, | Oct 30 2017 | Cilag GmbH International | Surgical instrument comprising an adaptive electrical system |
| 11793587, | Aug 15 2013 | Intuitive Surgical Operations, Inc. | Preloaded surgical instrument interface |
| 11801047, | Feb 14 2008 | Cilag GmbH International | Surgical stapling system comprising a control circuit configured to selectively monitor tissue impedance and adjust control of a motor |
| 11801051, | Jan 31 2006 | Cilag GmbH International | Accessing data stored in a memory of a surgical instrument |
| 11801098, | Oct 30 2017 | Cilag GmbH International | Method of hub communication with surgical instrument systems |
| 11806011, | Mar 22 2021 | Cilag GmbH International | Stapling instrument comprising tissue compression systems |
| 11806013, | Jun 28 2012 | Cilag GmbH International | Firing system arrangements for surgical instruments |
| 11811253, | Apr 18 2016 | Cilag GmbH International | Surgical robotic system with fault state detection configurations based on motor current draw |
| 11812954, | Sep 23 2008 | Cilag GmbH International | Robotically-controlled motorized surgical instrument with an end effector |
| 11812958, | Dec 18 2014 | Cilag GmbH International | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
| 11812960, | Jul 28 2004 | Cilag GmbH International | Method of segmenting the operation of a surgical stapling instrument |
| 11812961, | Jan 10 2007 | Cilag GmbH International | Surgical instrument including a motor control system |
| 11812964, | Feb 26 2021 | Cilag GmbH International | Staple cartridge comprising a power management circuit |
| 11812965, | Sep 30 2010 | Cilag GmbH International | Layer of material for a surgical end effector |
| 11818052, | Dec 28 2017 | Cilag GmbH International | Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs |
| 11819231, | Oct 30 2017 | Cilag GmbH International | Adaptive control programs for a surgical system comprising more than one type of cartridge |
| 11826012, | Mar 22 2021 | Cilag GmbH International | Stapling instrument comprising a pulsed motor-driven firing rack |
| 11826013, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with firing member closure features |
| 11826042, | Mar 22 2021 | Cilag GmbH International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
| 11826045, | Feb 12 2016 | Cilag GmbH International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
| 11826047, | May 28 2021 | Cilag GmbH International | Stapling instrument comprising jaw mounts |
| 11826048, | Jun 28 2017 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
| 11826132, | Mar 06 2015 | Cilag GmbH International | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
| 11832816, | Mar 24 2021 | Cilag GmbH International | Surgical stapling assembly comprising nonplanar staples and planar staples |
| 11832840, | Dec 28 2017 | Cilag GmbH International | Surgical instrument having a flexible circuit |
| 11832899, | Dec 28 2017 | Cilag GmbH International | Surgical systems with autonomously adjustable control programs |
| 11839352, | Jan 11 2007 | Cilag GmbH International | Surgical stapling device with an end effector |
| 11839375, | Aug 31 2005 | Cilag GmbH International | Fastener cartridge assembly comprising an anvil and different staple heights |
| 11839396, | Mar 08 2018 | Cilag GmbH International | Fine dissection mode for tissue classification |
| 11844516, | Dec 13 2019 | VYAS, DINESH | Stapler apparatus and methods for use |
| 11844518, | Oct 29 2020 | Cilag GmbH International | Method for operating a surgical instrument |
| 11844520, | Dec 19 2019 | Cilag GmbH International | Staple cartridge comprising driver retention members |
| 11844521, | Jan 10 2007 | Cilag GmbH International | Surgical instrument for use with a robotic system |
| 11844545, | Mar 08 2018 | Cilag GmbH International | Calcified vessel identification |
| 11844579, | Dec 28 2017 | Cilag GmbH International | Adjustments based on airborne particle properties |
| 11849939, | Dec 21 2017 | Cilag GmbH International | Continuous use self-propelled stapling instrument |
| 11849941, | Jun 29 2007 | Cilag GmbH International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
| 11849943, | Dec 02 2020 | Cilag GmbH International | Surgical instrument with cartridge release mechanisms |
| 11849944, | Mar 24 2021 | Cilag GmbH International | Drivers for fastener cartridge assemblies having rotary drive screws |
| 11849945, | Mar 24 2021 | Cilag GmbH International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
| 11849946, | Sep 23 2015 | Cilag GmbH International | Surgical stapler having downstream current-based motor control |
| 11849947, | Jan 10 2007 | Cilag GmbH International | Surgical system including a control circuit and a passively-powered transponder |
| 11849948, | Dec 21 2016 | Cilag GmbH International | Method for resetting a fuse of a surgical instrument shaft |
| 11849952, | Sep 30 2010 | Cilag GmbH International | Staple cartridge comprising staples positioned within a compressible portion thereof |
| 11850310, | Sep 30 2010 | INTERNATIONAL, CILAG GMBH; Cilag GmbH International | Staple cartridge including an adjunct |
| 11857181, | May 27 2011 | Cilag GmbH International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
| 11857182, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with combination function articulation joint arrangements |
| 11857183, | Mar 24 2021 | Cilag GmbH International | Stapling assembly components having metal substrates and plastic bodies |
| 11857187, | Sep 30 2010 | Cilag GmbH International | Tissue thickness compensator comprising controlled release and expansion |
| 11857189, | Jun 28 2012 | Cilag GmbH International | Surgical instrument including first and second articulation joints |
| 11864728, | Dec 28 2017 | Cilag GmbH International | Characterization of tissue irregularities through the use of mono-chromatic light refractivity |
| 11864756, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with flexible ball chain drive arrangements |
| 11864760, | Oct 29 2014 | Cilag GmbH International | Staple cartridges comprising driver arrangements |
| 11864845, | Dec 28 2017 | Cilag GmbH International | Sterile field interactive control displays |
| 11871901, | May 20 2012 | Cilag GmbH International | Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage |
| 11871923, | Sep 23 2008 | Cilag GmbH International | Motorized surgical instrument |
| 11871925, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with dual spherical articulation joint arrangements |
| 11871939, | Jun 20 2017 | Cilag GmbH International | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
| 11877745, | Oct 18 2021 | Cilag GmbH International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
| 11877748, | May 27 2011 | Cilag GmbH International | Robotically-driven surgical instrument with E-beam driver |
| 11882987, | Jul 28 2004 | Cilag GmbH International | Articulating surgical stapling instrument incorporating a two-piece E-beam firing mechanism |
| 11883019, | Dec 21 2017 | Cilag GmbH International | Stapling instrument comprising a staple feeding system |
| 11883020, | Jan 31 2006 | Cilag GmbH International | Surgical instrument having a feedback system |
| 11883024, | Jul 28 2020 | Cilag GmbH International | Method of operating a surgical instrument |
| 11883025, | Sep 30 2010 | Cilag GmbH International | Tissue thickness compensator comprising a plurality of layers |
| 11883026, | Apr 16 2014 | Cilag GmbH International | Fastener cartridge assemblies and staple retainer cover arrangements |
| 11890005, | Jun 29 2017 | Cilag GmbH International | Methods for closed loop velocity control for robotic surgical instrument |
| 11890008, | Jan 31 2006 | Cilag GmbH International | Surgical instrument with firing lockout |
| 11890010, | Dec 02 2020 | Cilag GmbH International | Dual-sided reinforced reload for surgical instruments |
| 11890012, | Jul 28 2004 | Cilag GmbH International | Staple cartridge comprising cartridge body and attached support |
| 11890015, | Sep 30 2015 | Cilag GmbH International | Compressible adjunct with crossing spacer fibers |
| 11890029, | Jan 31 2006 | Cilag GmbH International | Motor-driven surgical cutting and fastening instrument |
| 11890065, | Dec 28 2017 | Cilag GmbH International | Surgical system to limit displacement |
| 11896217, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising an articulation lock |
| 11896218, | Mar 24 2021 | Cilag GmbH International; INTERNATIONAL, CILAG GMBH | Method of using a powered stapling device |
| 11896219, | Mar 24 2021 | Cilag GmbH International | Mating features between drivers and underside of a cartridge deck |
| 11896222, | Dec 15 2017 | Cilag GmbH International | Methods of operating surgical end effectors |
| 11896225, | Jul 28 2004 | Cilag GmbH International | Staple cartridge comprising a pan |
| 11896322, | Dec 28 2017 | Cilag GmbH International | Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub |
| 11896443, | Dec 28 2017 | Cilag GmbH International | Control of a surgical system through a surgical barrier |
| 11903581, | Apr 30 2019 | Cilag GmbH International | Methods for stapling tissue using a surgical instrument |
| 11903582, | Mar 24 2021 | Cilag GmbH International | Leveraging surfaces for cartridge installation |
| 11903586, | Sep 30 2015 | Cilag GmbH International | Compressible adjunct with crossing spacer fibers |
| 11903587, | Dec 28 2017 | Cilag GmbH International | Adjustment to the surgical stapling control based on situational awareness |
| 11903601, | Dec 28 2017 | Cilag GmbH International | Surgical instrument comprising a plurality of drive systems |
| 11911027, | Sep 30 2010 | Cilag GmbH International | Adhesive film laminate |
| 11911028, | Jun 04 2007 | Cilag GmbH International | Surgical instruments for use with a robotic surgical system |
| 11911032, | Dec 19 2019 | Cilag GmbH International | Staple cartridge comprising a seating cam |
| 11911045, | Oct 30 2017 | Cilag GmbH International | Method for operating a powered articulating multi-clip applier |
| 11918208, | May 27 2011 | Cilag GmbH International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
| 11918209, | Aug 23 2013 | Cilag GmbH International | Torque optimization for surgical instruments |
| 11918210, | Oct 16 2014 | Cilag GmbH International | Staple cartridge comprising a cartridge body including a plurality of wells |
| 11918211, | Jan 10 2007 | Cilag GmbH International | Surgical stapling instrument for use with a robotic system |
| 11918212, | Mar 31 2015 | Cilag GmbH International | Surgical instrument with selectively disengageable drive systems |
| 11918213, | Jun 28 2012 | Cilag GmbH International | Surgical stapler including couplers for attaching a shaft to an end effector |
| 11918215, | Dec 21 2016 | Cilag GmbH International | Staple cartridge with array of staple pockets |
| 11918217, | May 28 2021 | Cilag GmbH International | Stapling instrument comprising a staple cartridge insertion stop |
| 11918220, | Mar 28 2012 | Cilag GmbH International | Tissue thickness compensator comprising tissue ingrowth features |
| 11918222, | Apr 16 2014 | Cilag GmbH International | Stapling assembly having firing member viewing windows |
| 11918302, | Dec 28 2017 | Cilag GmbH International | Sterile field interactive control displays |
| 11925346, | Jun 29 2007 | Cilag GmbH International | Surgical staple cartridge including tissue supporting surfaces |
| 11925347, | Dec 13 2019 | VYAS, DINESH | Stapler apparatus and methods for use |
| 11925349, | Feb 26 2021 | Cilag GmbH International | Adjustment to transfer parameters to improve available power |
| 11925350, | Feb 19 2019 | Cilag GmbH International | Method for providing an authentication lockout in a surgical stapler with a replaceable cartridge |
| 11925353, | Apr 16 2014 | Cilag GmbH International | Surgical stapling instrument comprising internal passage between stapling cartridge and elongate channel |
| 11925354, | Sep 30 2010 | Cilag GmbH International | Staple cartridge comprising staples positioned within a compressible portion thereof |
| 11925373, | Oct 30 2017 | Cilag GmbH International | Surgical suturing instrument comprising a non-circular needle |
| 11931025, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising a releasable closure drive lock |
| 11931027, | Mar 28 2018 | CILAG GMBH INTERNTIONAL | Surgical instrument comprising an adaptive control system |
| 11931028, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with multiple program responses during a firing motion |
| 11931031, | Oct 16 2014 | Cilag GmbH International | Staple cartridge comprising a deck including an upper surface and a lower surface |
| 11931032, | May 27 2011 | Cilag GmbH International | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
| 11931033, | Dec 19 2019 | Cilag GmbH International | Staple cartridge comprising a latch lockout |
| 11931034, | Dec 21 2016 | Cilag GmbH International | Surgical stapling instruments with smart staple cartridges |
| 11931038, | Oct 29 2014 | Cilag GmbH International | Cartridge assemblies for surgical staplers |
| 11931110, | Dec 28 2017 | Cilag GmbH International | Surgical instrument comprising a control system that uses input from a strain gage circuit |
| 11937769, | Dec 28 2017 | Cilag GmbH International | Method of hub communication, processing, storage and display |
| 11937814, | May 27 2011 | Cilag GmbH International | Surgical instrument for use with a robotic system |
| 11937816, | Oct 28 2021 | Cilag GmbH International | Electrical lead arrangements for surgical instruments |
| 11937817, | Mar 28 2018 | Cilag GmbH International | Surgical instruments with asymmetric jaw arrangements and separate closure and firing systems |
| 11944292, | Mar 28 2012 | Cilag GmbH International | Anvil layer attached to a proximal end of an end effector |
| 11944296, | Dec 02 2020 | Cilag GmbH International | Powered surgical instruments with external connectors |
| 11944299, | Dec 12 2012 | Cilag GmbH International | Surgical instrument having force feedback capabilities |
| 11944300, | Aug 03 2017 | Cilag GmbH International | Method for operating a surgical system bailout |
| 11944307, | Apr 16 2014 | Cilag GmbH International | Surgical stapling system including jaw windows |
| 11944308, | Sep 30 2015 | Cilag GmbH International | Compressible adjunct with crossing spacer fibers |
| 11944336, | Mar 24 2021 | Cilag GmbH International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
| 11944338, | Mar 06 2015 | Cilag GmbH International | Multiple level thresholds to modify operation of powered surgical instruments |
| 11950777, | Feb 26 2021 | Cilag GmbH International | Staple cartridge comprising an information access control system |
| 11950779, | Feb 26 2021 | Cilag GmbH International | Method of powering and communicating with a staple cartridge |
| 11957337, | Oct 18 2021 | Cilag GmbH International | Surgical stapling assembly with offset ramped drive surfaces |
| 11957339, | Aug 20 2018 | Cilag GmbH International | Method for fabricating surgical stapler anvils |
| 11957344, | Dec 21 2016 | Cilag GmbH International | Surgical stapler having rows of obliquely oriented staples |
| 11957345, | Mar 01 2013 | Cilag GmbH International | Articulatable surgical instruments with conductive pathways for signal communication |
| 11957795, | Sep 30 2010 | Cilag GmbH International | Tissue thickness compensator configured to redistribute compressive forces |
| 11963678, | Apr 16 2014 | Cilag GmbH International | Fastener cartridges including extensions having different configurations |
| 11963679, | Jul 28 2004 | Cilag GmbH International | Articulating surgical stapling instrument incorporating a two-piece E-beam firing mechanism |
| 11963680, | Oct 31 2017 | Cilag GmbH International | Cartridge body design with force reduction based on firing completion |
| 11969142, | Dec 28 2017 | Cilag GmbH International | Method of compressing tissue within a stapling device and simultaneously displaying the location of the tissue within the jaws |
| 11969216, | Dec 28 2017 | Cilag GmbH International | Surgical network recommendations from real time analysis of procedure variables against a baseline highlighting differences from the optimal solution |
| 11974741, | Jul 28 2020 | Cilag GmbH International | Surgical instruments with differential articulation joint arrangements for accommodating flexible actuators |
| 11974742, | Aug 03 2017 | Cilag GmbH International | Surgical system comprising an articulation bailout |
| 11974746, | Apr 16 2014 | Cilag GmbH International | Anvil for use with a surgical stapling assembly |
| 11974747, | May 27 2011 | Cilag GmbH International | Surgical stapling instruments with rotatable staple deployment arrangements |
| 11980362, | Feb 26 2021 | Cilag GmbH International | Surgical instrument system comprising a power transfer coil |
| 11980363, | Oct 18 2021 | Cilag GmbH International | Row-to-row staple array variations |
| 11980366, | May 27 2011 | Cilag GmbH International | Surgical instrument |
| 11980504, | May 25 2018 | Intuitive Surgical Operations, Inc. | Fiber Bragg grating end effector force sensor |
| 11986183, | Feb 14 2008 | Cilag GmbH International | Surgical cutting and fastening instrument comprising a plurality of sensors to measure an electrical parameter |
| 11986185, | Mar 28 2018 | Cilag GmbH International | Methods for controlling a surgical stapler |
| 11986233, | Mar 08 2018 | Cilag GmbH International | Adjustment of complex impedance to compensate for lost power in an articulating ultrasonic device |
| 11992208, | Jun 04 2007 | Cilag GmbH International | Rotary drive systems for surgical instruments |
| 11992213, | Dec 21 2016 | Cilag GmbH International | Surgical stapling instruments with replaceable staple cartridges |
| 11992214, | Mar 14 2013 | Cilag GmbH International | Control systems for surgical instruments |
| 11998193, | Dec 28 2017 | Cilag GmbH International | Method for usage of the shroud as an aspect of sensing or controlling a powered surgical device, and a control algorithm to adjust its default operation |
| 11998194, | Feb 15 2008 | Cilag GmbH International | Surgical stapling assembly comprising an adjunct applicator |
| 11998198, | Jul 28 2004 | Cilag GmbH International | Surgical stapling instrument incorporating a two-piece E-beam firing mechanism |
| 11998199, | Sep 29 2017 | Cilag GmbH International | System and methods for controlling a display of a surgical instrument |
| 11998200, | Jun 22 2007 | Cilag GmbH International | Surgical stapling instrument with an articulatable end effector |
| 11998201, | May 28 2021 | Cilag GmbH International | Stapling instrument comprising a firing lockout |
| 11998206, | Feb 14 2008 | Cilag GmbH International | Detachable motor powered surgical instrument |
| 11999065, | Oct 30 2020 | MAKO SURGICAL CORP | Robotic surgical system with motorized movement to a starting pose for a registration or calibration routine |
| 12053159, | Dec 28 2017 | Cilag GmbH International | Method of sensing particulate from smoke evacuated from a patient, adjusting the pump speed based on the sensed information, and communicating the functional parameters of the system to the hub |
| 12053175, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising a stowed closure actuator stop |
| 12053176, | Aug 23 2013 | Cilag GmbH International | End effector detention systems for surgical instruments |
| 12059124, | Dec 28 2017 | Cilag GmbH International | Surgical hub spatial awareness to determine devices in operating theater |
| 12059154, | May 27 2011 | Cilag GmbH International | Surgical instrument with detachable motor control unit |
| 12059169, | Dec 28 2017 | Cilag GmbH International | Controlling an ultrasonic surgical instrument according to tissue location |
| 12059218, | Oct 30 2017 | Cilag GmbH International | Method of hub communication with surgical instrument systems |
| 12062442, | Dec 28 2017 | Cilag GmbH International | Method for operating surgical instrument systems |
| 12064107, | Jul 28 2020 | Cilag GmbH International | Articulatable surgical instruments with articulation joints comprising flexible exoskeleton arrangements |
| 12076008, | Aug 20 2018 | Cilag GmbH International | Method for operating a powered articulatable surgical instrument |
| 12076010, | Dec 28 2017 | Cilag GmbH International | Surgical instrument cartridge sensor assemblies |
| 12076011, | Oct 30 2017 | Cilag GmbH International | Surgical stapler knife motion controls |
| 12076017, | Sep 18 2014 | Cilag GmbH International | Surgical instrument including a deployable knife |
| 12076018, | Feb 27 2015 | Cilag GmbH International | Modular stapling assembly |
| 12076096, | Dec 19 2017 | Cilag GmbH International | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
| 12076194, | Oct 29 2020 | Cilag GmbH International | Surgical instrument comprising an articulation indicator |
| 12082806, | Jan 10 2007 | Cilag GmbH International | Surgical instrument with wireless communication between control unit and sensor transponders |
| 12089841, | Oct 28 2021 | Cilag GmbH International | Staple cartridge identification systems |
| 12089849, | Apr 16 2014 | Cilag GmbH International | Staple cartridges including a projection |
| 12096916, | Dec 28 2017 | Cilag GmbH International | Method of sensing particulate from smoke evacuated from a patient, adjusting the pump speed based on the sensed information, and communicating the functional parameters of the system to the hub |
| 12096985, | Dec 28 2017 | Cilag GmbH International | Surgical network recommendations from real time analysis of procedure variables against a baseline highlighting differences from the optimal solution |
| 12102323, | Mar 24 2021 | Cilag GmbH International | Rotary-driven surgical stapling assembly comprising a floatable component |
| 12108950, | Dec 18 2014 | Cilag GmbH International | Surgical instrument assembly comprising a flexible articulation system |
| 12108951, | Feb 26 2021 | Cilag GmbH International | Staple cartridge comprising a sensing array and a temperature control system |
| 12114859, | Dec 10 2014 | Cilag GmbH International | Articulatable surgical instrument system |
| 12121234, | Mar 28 2012 | Cilag GmbH International | Staple cartridge assembly comprising a compensator |
| 12121255, | Oct 30 2017 | Cilag GmbH International | Electrical power output control based on mechanical forces |
| 12121256, | Mar 08 2018 | Cilag GmbH International | Methods for controlling temperature in ultrasonic device |
| D914878, | Aug 20 2018 | Cilag GmbH International | Surgical instrument anvil |
| D950728, | Jun 25 2019 | Cilag GmbH International | Surgical staple cartridge |
| D952144, | Jun 25 2019 | Cilag GmbH International | Surgical staple cartridge retainer with firing system authentication key |
| D964564, | Jun 25 2019 | Cilag GmbH International | Surgical staple cartridge retainer with a closure system authentication key |
| D966512, | Jun 02 2020 | Cilag GmbH International | Staple cartridge |
| D967421, | Jun 02 2020 | Cilag GmbH International | Staple cartridge |
| D974560, | Jun 02 2020 | Cilag GmbH International | Staple cartridge |
| D975278, | Jun 02 2020 | Cilag GmbH International | Staple cartridge |
| D975850, | Jun 02 2020 | Cilag GmbH International | Staple cartridge |
| D975851, | Jun 02 2020 | Cilag GmbH International | Staple cartridge |
| D976401, | Jun 02 2020 | Cilag GmbH International | Staple cartridge |
| D980425, | Oct 29 2020 | Cilag GmbH International | Surgical instrument assembly |
| ER1904, | |||
| ER2106, | |||
| ER2640, | |||
| ER3311, | |||
| ER3991, | |||
| ER4139, | |||
| ER421, | |||
| ER4905, | |||
| ER4916, | |||
| ER4979, | |||
| ER5159, | |||
| ER5288, | |||
| ER5625, | |||
| ER5649, | |||
| ER5681, | |||
| ER5971, | |||
| ER6389, | |||
| ER6520, | |||
| ER6563, | |||
| ER7067, | |||
| ER7212, | |||
| ER7906, | |||
| ER8736, | |||
| ER9020, | |||
| ER9076, | |||
| ER9298, | |||
| ER9344, | |||
| ER9364, | |||
| ER9533, | |||
| ER9597, | |||
| ER9831, |
| Patent | Priority | Assignee | Title |
| 10004491, | Jun 15 2015 | Cilag GmbH International | Suturing instrument with needle motion indicator |
| 10004500, | Sep 02 2014 | Cilag GmbH International | Devices and methods for manually retracting a drive shaft, drive beam, and associated components of a surgical fastening device |
| 10004527, | Nov 26 2013 | Cilag GmbH International | Ultrasonic surgical instrument with staged clamping |
| 10022120, | May 26 2015 | Ethicon LLC | Surgical needle with recessed features |
| 10022391, | May 13 2008 | CHIESI FARMACEUTICI S P A | Maintenance of platelet inhibition during antiplatelet therapy |
| 10022568, | Aug 06 2008 | Cilag GmbH International | Devices and techniques for cutting and coagulating tissue |
| 10034704, | Jun 30 2015 | Cilag GmbH International | Surgical instrument with user adaptable algorithms |
| 10041822, | Oct 05 2007 | Covidien LP | Methods to shorten calibration times for powered devices |
| 10045781, | Jun 13 2014 | Cilag GmbH International | Closure lockout systems for surgical instruments |
| 10045813, | Oct 30 2009 | Covidien LP | Jaw roll joint |
| 10052044, | Mar 06 2015 | Cilag GmbH International | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
| 10076326, | Sep 23 2015 | Cilag GmbH International | Surgical stapler having current mirror-based motor control |
| 10080618, | Jul 22 2015 | CMR Surgical Limited | Gear packaging for robotic arms |
| 10085749, | Feb 26 2015 | Covidien LP | Surgical apparatus with conductor strain relief |
| 10098527, | Feb 27 2013 | Cilag GmbH International | System for performing a minimally invasive surgical procedure |
| 10098635, | Nov 13 2009 | Intuitive Surgical Operations, Inc. | End effector with redundant closing mechanisms |
| 10098705, | Apr 01 2014 | Intuitive Surgical Operations, Inc. | Control input accuracy for teleoperated surgical instrument |
| 10105142, | Sep 18 2014 | Cilag GmbH International | Surgical stapler with plurality of cutting elements |
| 10111665, | Feb 19 2015 | Covidien LP | Electromechanical surgical systems |
| 10117651, | Sep 21 2007 | Covidien LP | Surgical device having a rotatable jaw portion |
| 10117702, | Apr 10 2015 | Cilag GmbH International | Surgical generator systems and related methods |
| 10118119, | Jun 08 2015 | CTS Corporation | Radio frequency process sensing, control, and diagnostics network and system |
| 10130360, | Oct 04 2002 | Siteco GmbH | Surgical stapler with universal articulation and tissue pre-clamp |
| 10130367, | Feb 26 2015 | Covidien LP | Surgical apparatus |
| 10133248, | Apr 28 2014 | Covidien LP | Systems and methods for determining an end of life state for surgical devices |
| 10136949, | Aug 17 2015 | Cilag GmbH International | Gathering and analyzing data for robotic surgical systems |
| 10143948, | Aug 14 2015 | 3M Innovative Properties Company | Identification of filter media within a filtration system |
| 10152789, | Jul 25 2014 | Covidien LP | Augmented surgical reality environment |
| 10159044, | Dec 09 2013 | GM Global Technology Operations LLC | Method and apparatus for controlling operating states of bluetooth interfaces of a bluetooth module |
| 10159481, | Apr 27 2009 | Covidien LP | Device and method for controlling compression of tissue |
| 10159483, | Feb 27 2015 | Cilag GmbH International | Surgical apparatus configured to track an end-of-life parameter |
| 10164466, | Apr 17 2014 | Covidien LP | Non-contact surgical adapter electrical interface |
| 10172687, | Mar 17 2014 | Intuitive Surgical Operations, Inc | Surgical cannulas and related systems and methods of identifying surgical cannulas |
| 10175096, | Apr 01 2016 | Cilag GmbH International | System and method to enable re-use of surgical instrument |
| 10175127, | May 05 2014 | Covidien LP | End-effector force measurement drive circuit |
| 10179413, | Dec 11 2013 | Covidien LP | Wrist and jaw assemblies for robotic surgical systems |
| 10182814, | Jun 18 2010 | Covidien LP | Staple position sensor system |
| 10188385, | Dec 18 2014 | Cilag GmbH International | Surgical instrument system comprising lockable systems |
| 10194907, | Jul 18 2012 | Covidien LP | Multi-fire stapler with electronic counter, lockout, and visual indicator |
| 10194913, | Jul 30 2015 | Cilag GmbH International | Surgical instrument comprising systems for assuring the proper sequential operation of the surgical instrument |
| 10201349, | Aug 23 2013 | Cilag GmbH International | End effector detection and firing rate modulation systems for surgical instruments |
| 10206605, | Mar 06 2015 | Cilag GmbH International | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
| 10206752, | May 14 2015 | CMR Surgical Limited | Torque sensing in a surgical robotic wrist |
| 10213266, | Feb 07 2014 | Covidien LP | Robotic surgical assemblies and adapter assemblies thereof |
| 10213268, | Mar 17 2014 | Intuitive Surgical Operations, Inc.; Intuitive Surgical Operations, Inc | Latch release for surgical instrument |
| 10226250, | Feb 27 2015 | Cilag GmbH International | Modular stapling assembly |
| 10231634, | Apr 15 2005 | Surgisense Corporation | Surgical instruments with sensors for detecting tissue properties, and system using such instruments |
| 10238413, | Dec 16 2015 | Cilag GmbH International | Surgical instrument with multi-function button |
| 10245037, | Dec 07 2011 | Edwards Lifesciences Corporation | Self-cinching surgical clips and delivery system |
| 10245038, | Jun 11 2014 | Applied Medical Resources Corporation | Surgical stapler with circumferential firing |
| 10251661, | Aug 27 2013 | Covidien LP | Hand held electromechanical surgical handle assembly for use with surgical end effectors, and methods of use |
| 10258359, | Aug 13 2014 | Covidien LP | Robotically controlling mechanical advantage gripping |
| 10258362, | Jul 12 2016 | Cilag GmbH International | Ultrasonic surgical instrument with AD HOC formed blade |
| 10263171, | Oct 09 2009 | Cilag GmbH International | Surgical generator for ultrasonic and electrosurgical devices |
| 10265035, | Jun 01 2016 | SIEMENS HEALTHINEERS AG | Method and device for motion control of a mobile medical device |
| 10265090, | Jan 16 2013 | Covidien LP | Hand held electromechanical surgical system including battery compartment diagnostic display |
| 10265130, | Dec 11 2015 | Ethicon LLC | Systems, devices, and methods for coupling end effectors to surgical devices and loading devices |
| 10271840, | Sep 18 2013 | Covidien LP | Apparatus and method for differentiating between tissue and mechanical obstruction in a surgical instrument |
| 10271844, | May 03 2017 | Covidien LP | Surgical stapling apparatus employing a predictive stapling algorithm |
| 10278698, | Feb 23 2011 | Covidien LP | Controlled tissue compression systems and methods |
| 10278778, | Oct 27 2016 | INNEROPTIC TECHNOLOGY, INC | Medical device navigation using a virtual 3D space |
| 10285705, | Apr 01 2016 | Cilag GmbH International | Surgical stapling system comprising a grooved forming pocket |
| 10292758, | Oct 10 2014 | Ethicon LLC | Methods and devices for articulating laparoscopic energy device |
| 10307170, | Jun 20 2017 | Cilag GmbH International | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
| 10307199, | Jun 22 2006 | Board of Regents of the University of Nebraska | Robotic surgical devices and related methods |
| 10314577, | Jun 25 2014 | Cilag GmbH International | Lockout engagement features for surgical stapler |
| 10321964, | Sep 15 2014 | Covidien LP | Robotically controlling surgical assemblies |
| 10335147, | Jun 25 2014 | Cilag GmbH International | Method of using lockout features for surgical stapler cartridge |
| 10335227, | Apr 24 2009 | Covidien LP | Electrosurgical tissue sealer and cutter |
| 10342543, | Apr 01 2016 | Cilag GmbH International | Surgical stapling system comprising a shiftable transmission |
| 10342602, | Mar 17 2015 | Cilag GmbH International | Managing tissue treatment |
| 10342623, | Mar 12 2014 | PROXIMED, LLC | Surgical guidance systems, devices, and methods |
| 10357247, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with multiple program responses during a firing motion |
| 10362179, | Jan 09 2015 | TRACFONE WIRELESS, INC | Peel and stick activation code for activating service for a wireless device |
| 10363037, | Apr 18 2016 | Cilag GmbH International | Surgical instrument system comprising a magnetic lockout |
| 10368865, | Dec 30 2015 | Cilag GmbH International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
| 10368867, | Apr 18 2016 | Cilag GmbH International | Surgical instrument comprising a lockout |
| 10368876, | Jan 15 2015 | Covidien LP | Endoscopic reposable surgical clip applier |
| 10368894, | Dec 21 2015 | Cilag GmbH International | Surgical instrument with variable clamping force |
| 10376305, | Aug 05 2016 | Cilag GmbH International | Methods and systems for advanced harmonic energy |
| 10376337, | Dec 12 2012 | SRI International | Hyperdexterous surgical system |
| 10376338, | May 13 2014 | Covidien LP | Surgical robotic arm support systems and methods of use |
| 10383518, | Mar 31 2015 | Midmark Corporation | Electronic ecosystem for medical examination room |
| 10383699, | Mar 15 2013 | SRI International | Hyperdexterous surgical system |
| 10390831, | Nov 10 2015 | Covidien LP | Endoscopic reposable surgical clip applier |
| 10390895, | Aug 16 2016 | Cilag GmbH International | Control of advancement rate and application force based on measured forces |
| 10398517, | Aug 16 2016 | Cilag GmbH International | Surgical tool positioning based on sensed parameters |
| 10420558, | Jul 30 2015 | Cilag GmbH International | Surgical instrument comprising a system for bypassing an operational step of the surgical instrument |
| 10420620, | Mar 10 2015 | Covidien LP | Robotic surgical systems, instrument drive units, and drive assemblies |
| 10420865, | Mar 06 2014 | Stryker Corporation | Medical/surgical waste collection unit with a light assembly separate from the primary display, the light assembly presenting information about the operation of the system by selectively outputting light |
| 10422727, | Aug 10 2014 | Contaminant monitoring and air filtration system | |
| 10426466, | Apr 22 2015 | Covidien LP | Handheld electromechanical surgical system |
| 10426467, | Apr 15 2016 | Cilag GmbH International | Surgical instrument with detection sensors |
| 10426468, | Apr 22 2015 | Covidien LP | Handheld electromechanical surgical system |
| 10441279, | Mar 06 2015 | Cilag GmbH International | Multiple level thresholds to modify operation of powered surgical instruments |
| 10441345, | Oct 09 2009 | Cilag GmbH International | Surgical generator for ultrasonic and electrosurgical devices |
| 3082426, | |||
| 3584628, | |||
| 3759017, | |||
| 4448193, | Feb 26 1982 | Ethicon, Inc. | Surgical clip applier with circular clip magazine |
| 4523695, | Feb 10 1982 | Intermedicat GmbH | Surgical stapler |
| 4701193, | Sep 11 1985 | Coherent, Inc | Smoke evacuator system for use in laser surgery |
| 4735603, | Sep 10 1986 | GOODSON, JAMES H | Laser smoke evacuation system and method |
| 4788977, | Jul 04 1985 | ERBE ELEKTROMEDIZIN GMBH | High-frequency surgical instrument |
| 5042460, | Oct 25 1988 | Olympus Optical Co., Ltd. | Ultrasonic treating apparatus with device for inhibiting drive when ultrasonic element is determined to be defective |
| 5084057, | Jul 18 1989 | United States Surgical Corporation | Apparatus and method for applying surgical clips in laparoscopic or endoscopic procedures |
| 5100402, | Oct 05 1990 | MEGADYNE MEDICAL PRODUCTS, INC | Electrosurgical laparoscopic cauterization electrode |
| 5151102, | May 31 1989 | KYOCERA CORPORATION, A CORP OF JAPAN; KAMIYAMA, HIROYASU | Blood vessel coagulation/stanching device |
| 5197962, | Jun 05 1991 | Megadyne Medical Products, Inc. | Composite electrosurgical medical instrument |
| 5242474, | Nov 01 1991 | Sorenson Laboratories, Inc. | Dual mode laser smoke evacuation system with sequential filter monitor and vacuum compensation |
| 5318516, | May 23 1990 | I C MEDICAL, INC | Radio frequency sensor for automatic smoke evacuator system for a surgical laser and/or electrical apparatus and method therefor |
| 5342349, | Aug 18 1993 | Sorenson Laboratories, Inc.; SORENSON LABORATORIES, INC | Apparatus and system for coordinating a surgical plume evacuator and power generator |
| 5383880, | Jan 17 1992 | Ethicon, Inc. | Endoscopic surgical system with sensing means |
| 5396900, | Apr 04 1991 | Symbiosis Corporation | Endoscopic end effectors constructed from a combination of conductive and non-conductive materials and useful for selective endoscopic cautery |
| 5397046, | Oct 18 1991 | United States Surgical Corporation | Lockout mechanism for surgical apparatus |
| 5403327, | Dec 31 1992 | Applied Medical Resources Corporation | Surgical clip applier |
| 5417699, | Dec 10 1992 | Abbott Laboratories | Device and method for the percutaneous suturing of a vascular puncture site |
| 5439468, | May 07 1993 | Ethicon Endo-Surgery | Surgical clip applier |
| 5467911, | Apr 27 1993 | Olympus Optical Co., Ltd. | Surgical device for stapling and fastening body tissues |
| 5474566, | May 05 1994 | United States Surgical Corporation | Self-contained powered surgical apparatus |
| 5496315, | Aug 26 1994 | Megadyne Medical Products, Inc. | Medical electrode insulating system |
| 5503320, | Aug 19 1993 | United States Surgical Corporation | Surgical apparatus with indicator |
| 5531743, | Nov 18 1994 | Megadyne Medical Products, Inc. | Resposable electrode |
| 5610379, | Feb 04 1995 | Nicolay Verwaltungs -GmbH | Liquid and gas impenetrable switch |
| 5613966, | Dec 21 1994 | Covidien AG; TYCO HEALTHCARE GROUP AG | System and method for accessory rate control |
| 5643291, | Sep 29 1994 | United States Surgical Corporation | Surgical clip applicator |
| 5654750, | Feb 23 1995 | VideoRec Technologies, Inc. | Automatic recording system |
| 5673841, | Dec 19 1994 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
| 5675227, | Sep 25 1992 | GE Medical Systems | Device for maneuvering a radiology appliance |
| 5693052, | Sep 01 1995 | Megadyne Medical Products, Inc. | Coated bipolar electrocautery |
| 5697926, | Dec 17 1992 | Megadyne Medical Products, Inc. | Cautery medical instrument |
| 5706998, | Jul 17 1995 | United States Surgical Corporation | Surgical stapler with alignment pin locking mechanism |
| 5725542, | Mar 09 1995 | Multifunctional spring clips and cartridges and applicators therefor | |
| 5746209, | Jan 26 1996 | MARYLAND, BALTIMORE, UNIVERSITY OF | Method of and apparatus for histological human tissue characterizationusing ultrasound |
| 5749362, | May 27 1992 | International Business Machines Corporation | Method of creating an image of an anatomical feature where the feature is within a patient's body |
| 5749893, | Apr 30 1993 | Tyco Healthcare Group LP | Surgical instrument having an articulated jaw structure and a detachable knife |
| 5817093, | Jul 22 1993 | Ethicon Endo-Surgery, Inc. | Impedance feedback monitor with query electrode for electrosurgical instrument |
| 5836909, | Sep 13 1996 | I C MEDICAL, INC | Automatic fluid control system for use in open and laparoscopic laser surgery and electrosurgery and method therefor |
| 5843080, | Oct 16 1996 | Megadyne Medical Products, Inc. | Bipolar instrument with multi-coated electrodes |
| 5846237, | Nov 18 1994 | Megadyne Medical Products, Inc. | Insulated implement |
| 5849022, | Jul 29 1994 | Olympus Optical Co., Ltd. | Medical instrument for use in combination with endoscopes |
| 5893849, | Dec 17 1992 | Megadyne Medical Products, Inc. | Cautery medical instrument |
| 5906625, | Jun 04 1992 | OLYMPUS OPTICAL CO , LTD | Tissue-fixing surgical instrument, tissue-fixing device, and method of fixing tissue |
| 5942333, | Mar 27 1995 | Texas Research Institute | Non-conductive coatings for underwater connector backshells |
| 5968032, | Mar 30 1998 | Smoke evacuator for a surgical laser or cautery plume | |
| 6030437, | Mar 11 1997 | U S PHILIPS CORPORATION | Gas purifier |
| 6036637, | Dec 13 1994 | Olympus Optical Co., Ltd. | Treating system utilizing an endoscope |
| 6039735, | Oct 03 1997 | Megadyne Medical Products, Inc. | Electric field concentrated electrosurgical electrode |
| 6059799, | Jun 25 1998 | United States Surgical Corporation | Apparatus for applying surgical clips |
| 6066137, | Oct 03 1997 | Megadyne Medical Products, Inc. | Electric field concentrated electrosurgical electrode |
| 6090107, | Oct 20 1998 | Megadyne Medical Products, Inc. | Resposable electrosurgical instrument |
| 6099537, | Feb 26 1996 | Olympus Optical Co., Ltd. | Medical treatment instrument |
| 6214000, | Oct 30 1996 | MEGADYNE MEDICAL PRODUCTS, INC | Capacitive reusable electrosurgical return electrode |
| 6273887, | Jan 23 1998 | Olympus Corporation | High-frequency treatment tool |
| 6301495, | Apr 27 1999 | International Business Machines Corporation | System and method for intra-operative, image-based, interactive verification of a pre-operative surgical plan |
| 6302881, | Dec 29 1998 | ERBE ELEKTROMEDIZIN GMBH | Method and apparatus for the removal of smoke during high-frequency surgery |
| 6391102, | Mar 21 2000 | MICROTEK MEDICAL, INC | Air filtration system with filter efficiency management |
| 6443973, | Jun 02 1999 | Covidien LP | Electromechanical driver device for use with anastomosing, stapling, and resecting instruments |
| 6461352, | May 11 1999 | Stryker Corporation | Surgical handpiece with self-sealing switch assembly |
| 6530933, | Dec 31 1998 | Kensey Nash Corporation | Methods and devices for fastening bulging or herniated intervertebral discs |
| 6551243, | Jan 24 2001 | Siemens Medical Solutions USA, Inc | System and user interface for use in providing medical information and health care delivery support |
| 6569109, | Feb 04 2000 | Olympus Corporation | Ultrasonic operation apparatus for performing follow-up control of resonance frequency drive of ultrasonic oscillator by digital PLL system using DDS (direct digital synthesizer) |
| 6582424, | Oct 30 1996 | MEGA-DYNE MEDICAL PRODUCTS, INC | Capacitive reusable electrosurgical return electrode |
| 6618626, | Jan 16 2001 | HS WEST INVESTMENTS, LLC | Apparatus and methods for protecting the axillary nerve during thermal capsullorhaphy |
| 6685704, | Feb 26 2002 | Megadyne Medical Products, Inc. | Utilization of an active catalyst in a surface coating of an electrosurgical instrument |
| 6783525, | Dec 12 2001 | Megadyne Medical Products, Inc. | Application and utilization of a water-soluble polymer on a surface |
| 6869435, | Jan 17 2002 | Repeating multi-clip applier | |
| 6945981, | Oct 20 2000 | Ethicon-Endo Surgery, Inc. | Finger operated switch for controlling a surgical handpiece |
| 6951559, | Jun 21 2002 | Megadyne Medical Products, Inc. | Utilization of a hybrid material in a surface coating of an electrosurgical instrument |
| 7000818, | May 20 2003 | Cilag GmbH International | Surgical stapling instrument having separate distinct closing and firing systems |
| 7048775, | Oct 17 2001 | Sartorius Stedim Biotech GmbH | Device and method for monitoring the integrity of filtering installations |
| 7053752, | Aug 06 1996 | Intuitive Surgical Operations, Inc | General purpose distributed operating room control system |
| 7077853, | Oct 20 2000 | Ethicon Endo-Surgery, Inc. | Method for calculating transducer capacitance to determine transducer temperature |
| 7097640, | Jun 24 1996 | Intuitive Surgical Operations, Inc | Multi-functional surgical control system and switching interface |
| 7169145, | Nov 21 2003 | Megadyne Medical Products, Inc. | Tuned return electrode with matching inductor |
| 7177533, | Sep 24 2000 | Medtronic, Inc.; Medtronic, Inc | Motor control system for a surgical handpiece |
| 7182775, | Feb 27 2003 | Microline Surgical, Inc | Super atraumatic grasper apparatus |
| 7230529, | Feb 07 2003 | THERADOC, INC | System, method, and computer program for interfacing an expert system to a clinical information system |
| 7236817, | Mar 03 2000 | TRUE LIFE CREATIONS SA PTY LTD ; MACROPACE PRODUCTS PTY LTD | Animation technology |
| 7294116, | Jan 03 2005 | Ellman International, Inc | Surgical smoke plume evacuation system |
| 7317955, | Dec 12 2003 | Conmed Corporation | Virtual operating room integration |
| 7328828, | Nov 04 2005 | Ethicon Endo-Surgery, Inc,; Ethicon Endo-Surgery, Inc | Lockout mechanisms and surgical instruments including same |
| 7371227, | Dec 17 2004 | Cilag GmbH International | Trocar seal assembly |
| 7380695, | May 20 2003 | Cilag GmbH International | Surgical stapling instrument having a single lockout mechanism for prevention of firing |
| 7383088, | Nov 07 2001 | Cardiac Pacemakers, Inc | Centralized management system for programmable medical devices |
| 7407074, | Jul 28 2004 | Cilag GmbH International | Electroactive polymer-based actuation mechanism for multi-fire surgical fastening instrument |
| 7464847, | Jun 03 2005 | Covidien LP | Surgical stapler with timer and feedback display |
| 7575144, | Jan 31 2006 | Ethicon Endo-Surgery, Inc | Surgical fastener and cutter with single cable actuator |
| 7621898, | Dec 14 2005 | Stryker Corporation | Medical/surgical waste collection unit including waste containers of different storage volumes with inter-container transfer valve and independently controlled vacuum levels |
| 7667839, | Mar 30 2006 | Particle Measuring Systems, Inc. | Aerosol particle sensor with axial fan |
| 7721934, | Jan 31 2006 | Ethicon Endo-Surgery, Inc. | Articulatable drive shaft arrangements for surgical cutting and fastening instruments |
| 7766905, | Feb 12 2004 | TYCO HEALTHCARE GROUP AG; Covidien AG | Method and system for continuity testing of medical electrodes |
| 7776037, | Jul 07 2006 | TYCO HEALTHCARE GROUP AG; Covidien AG | System and method for controlling electrode gap during tissue sealing |
| 7784663, | Mar 17 2005 | Cilag GmbH International | Surgical stapling instrument having load sensing control circuitry |
| 7837079, | Aug 15 2005 | Covidien LP | Surgical stapling instruments including a cartridge having multiple staple sizes |
| 7837680, | Nov 21 2003 | Megadyne Medical Products, Inc. | Tuned return electrode with matching inductor |
| 7845537, | Jan 31 2006 | Cilag GmbH International | Surgical instrument having recording capabilities |
| 7862560, | Mar 23 2007 | Arthrocare Corporation | Ablation apparatus having reduced nerve stimulation and related methods |
| 7862579, | Jul 28 2004 | Cilag GmbH International | Electroactive polymer-based articulation mechanism for grasper |
| 7918230, | Sep 21 2007 | Covidien LP | Surgical device having a rotatable jaw portion |
| 7955322, | Dec 20 2005 | Intuitive Surgical Operations, Inc | Wireless communication in a robotic surgical system |
| 7966269, | Oct 20 2005 | Intelligent human-machine interface | |
| 7976553, | Jun 13 2005 | Ethicon Endo-Surgery, Inc | Surgical suturing apparatus with detachable handle |
| 7982776, | Jul 13 2007 | Ethicon Endo-Surgery, Inc | SBI motion artifact removal apparatus and method |
| 7988028, | Sep 23 2008 | Covidien LP | Surgical instrument having an asymmetric dynamic clamping member |
| 7995045, | Apr 13 2007 | Ethicon Endo-Surgery, Inc. | Combined SBI and conventional image processor |
| 8012170, | Apr 27 2009 | Covidien LP | Device and method for controlling compression of tissue |
| 8054184, | Jul 31 2008 | Intuitive Surgical Operations, Inc | Identification of surgical instrument attached to surgical robot |
| 8062306, | Dec 14 2006 | Ethicon Endo-Surgery, Inc | Manually articulating devices |
| 8066721, | Dec 06 2000 | Ethicon Endo-Surgery, Inc | Surgical clip application assembly |
| 8096459, | Oct 11 2005 | Ethicon Endo-Surgery, Inc | Surgical stapler with an end effector support |
| 8120301, | Mar 09 2009 | Intuitive Surgical Operations, Inc | Ergonomic surgeon control console in robotic surgical systems |
| 8123764, | Sep 20 2004 | Intuitive Surgical Operations, Inc | Apparatus and method for minimally invasive suturing |
| 8131565, | Oct 24 2006 | HEALTHCARE FINANCIAL SOLUTIONS, LLC, AS SUCCESSOR ADMINISTRATIVE AGENT | System for medical data collection and transmission |
| 8160098, | Jan 14 2009 | Cisco Technology, Inc.; Cisco Technology, Inc | Dynamically allocating channel bandwidth between interfaces |
| 8172836, | Aug 11 2008 | Covidien LP | Electrosurgical system having a sensor for monitoring smoke or aerosols |
| 8181839, | Jun 03 2005 | Covidien LP | Surgical instruments employing sensors |
| 8185409, | Nov 29 2001 | INTEGRATION MANAGEMENT, INC | Method and apparatus for operative event documentation and related data management |
| 8206345, | Mar 07 2005 | Medtronic Cryocath LP | Fluid control system for a medical device |
| 8229549, | Jul 09 2004 | Covidien LP | Surgical imaging device |
| 8257387, | Aug 15 2008 | Covidien LP | Method of transferring pressure in an articulating surgical instrument |
| 8321581, | Oct 19 2007 | Voxer IP LLC | Telecommunication and multimedia management method and apparatus |
| 8335590, | Dec 23 2008 | Intuitive Surgical Operations, Inc | System and method for adjusting an image capturing device attribute using an unused degree-of-freedom of a master control device |
| 8398541, | Jun 06 2006 | Intuitive Surgical Operations, Inc | Interactive user interfaces for robotic minimally invasive surgical systems |
| 8403946, | Jul 28 2010 | Covidien LP | Articulating clip applier cartridge |
| 8428722, | Nov 30 2005 | Medtronic, Inc. | Communication system for medical devices |
| 8439910, | Jan 22 2010 | MEGADYNE MEDICAL PRODUCTS, INC | Electrosurgical electrode with electric field concentrating flash edge |
| 8444663, | Feb 27 2004 | Cilag GmbH International | Ultrasonic surgical shears and tissue pad for same |
| 8452615, | Nov 13 2007 | KARL STORZ SE & CO KG | Method and system for management of operating-room resources |
| 8469973, | Jan 27 2006 | Intuitive Surgical Operations, Inc | Apparatus and method for sternotomy closure |
| 8472630, | Nov 06 2009 | Roche Diabetes Care, Inc | Method and system for establishing cryptographic communications between a remote device and a medical device |
| 8476227, | Jan 22 2010 | THE GENERAL HOSPITAL CORPORATION D B A MASSACHUSETTS GENERAL HOSPITAL | Methods of activating a melanocortin-4 receptor pathway in obese subjects |
| 8499992, | Apr 27 2009 | Covidien LP | Device and method for controlling compression of tissue |
| 8505801, | Oct 13 2000 | Covidien LP | Surgical fastener applying apparatus |
| 8512365, | Jul 31 2007 | Cilag GmbH International | Surgical instruments |
| 8620473, | Jun 13 2007 | Intuitive Surgical Operations, Inc | Medical robotic system with coupled control modes |
| 8627995, | May 19 2006 | Cilag GmbH International | Electrically self-powered surgical instrument with cryptographic identification of interchangeable part |
| 8628545, | Jun 13 2008 | Covidien LP | Endoscopic stitching devices |
| 8632525, | Sep 17 2010 | Cilag GmbH International | Power control arrangements for surgical instruments and batteries |
| 8657176, | Sep 30 2010 | Ethicon Endo-Surgery, Inc | Tissue thickness compensator for a surgical stapler |
| 8657177, | Oct 25 2011 | Covidien LP | Surgical apparatus and method for endoscopic surgery |
| 8663220, | Jul 15 2009 | Cilag GmbH International | Ultrasonic surgical instruments |
| 8682049, | Feb 14 2012 | Terarecon, INC | Cloud-based medical image processing system with access control |
| 8682489, | Nov 13 2009 | Intuitive Sugical Operations, Inc. | Method and system for hand control of a teleoperated minimally invasive slave surgical instrument |
| 8685056, | Aug 18 2011 | Covidien LP | Surgical forceps |
| 8752749, | Feb 14 2008 | Cilag GmbH International | Robotically-controlled disposable motor-driven loading unit |
| 8763879, | Jan 31 2006 | Cilag GmbH International | Accessing data stored in a memory of surgical instrument |
| 8771270, | Jul 16 2008 | Intuitive Surgical Operations, Inc | Bipolar cautery instrument |
| 8775196, | Jan 29 2002 | Baxter International Inc | System and method for notification and escalation of medical data |
| 8779648, | Aug 06 2008 | Cilag GmbH International | Ultrasonic device for cutting and coagulating with stepped output |
| 8799009, | Feb 02 2009 | Change Healthcare Holdings, LLC | Systems, methods and apparatuses for predicting capacity of resources in an institution |
| 8801703, | Aug 01 2007 | Covidien LP | System and method for return electrode monitoring |
| 8818556, | Jan 13 2011 | Microsoft Technology Licensing, LLC | Multi-state model for robot and user interaction |
| 8820603, | Sep 23 2008 | Cilag GmbH International | Accessing data stored in a memory of a surgical instrument |
| 8820608, | Nov 16 2011 | Olympus Corporation | Medical instrument |
| 8852174, | Nov 13 2009 | Intuitive Surgical Operations, Inc | Surgical tool with a two degree of freedom wrist |
| 8875973, | Jul 12 1999 | Covidien LP | Expanding parallel jaw device for use with an electromechanical driver device |
| 8905977, | Jul 28 2004 | Cilag GmbH International | Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser |
| 8912746, | Oct 26 2011 | Intuitive Surgical Operations, Inc | Surgical instrument motor pack latch |
| 8920433, | Jul 31 2009 | Dexterite Surgical | Ergonomic and semi-automatic manipulator, and applications to instruments for minimally invasive surgery |
| 8960520, | Oct 05 2007 | Covidien LP | Method and apparatus for determining parameters of linear motion in a surgical instrument |
| 8962062, | Jan 10 2012 | Covidien LP | Methods of manufacturing end effectors for energy-based surgical instruments |
| 8968309, | Nov 10 2011 | Covidien LP | Surgical forceps |
| 8968337, | Jul 28 2010 | Covidien LP | Articulating clip applier |
| 8968358, | Aug 05 2009 | Covidien LP | Blunt tissue dissection surgical instrument jaw designs |
| 8986302, | Oct 09 2009 | Cilag GmbH International | Surgical generator for ultrasonic and electrosurgical devices |
| 8989903, | Feb 15 2011 | Intuitive Surgical Operations, Inc | Methods and systems for indicating a clamping prediction |
| 9011427, | Nov 05 2010 | Cilag GmbH International | Surgical instrument safety glasses |
| 9017326, | Jul 15 2009 | Cilag GmbH International | Impedance monitoring apparatus, system, and method for ultrasonic surgical instruments |
| 9027431, | May 15 2009 | Katholieke Universiteit Leuven | Remote centre of motion positioner |
| 9028494, | Jun 28 2012 | Cilag GmbH International | Interchangeable end effector coupling arrangement |
| 9038882, | Feb 03 2012 | Covidien LP | Circular stapling instrument |
| 9044244, | Dec 10 2010 | BIOSENSE WEBSTER ISRAEL , LTD | System and method for detection of metal disturbance based on mutual inductance measurement |
| 9044261, | Jul 31 2007 | Cilag GmbH International | Temperature controlled ultrasonic surgical instruments |
| 9055035, | Apr 05 2011 | Roche Diabetes Care, Inc | Medical device with secure data transmission |
| 9060770, | Oct 03 2006 | Cilag GmbH International | Robotically-driven surgical instrument with E-beam driver |
| 9060775, | Oct 09 2009 | Cilag GmbH International | Surgical generator for ultrasonic and electrosurgical devices |
| 9072535, | May 27 2011 | Cilag GmbH International | Surgical stapling instruments with rotatable staple deployment arrangements |
| 9072536, | Jun 28 2012 | Cilag GmbH International | Differential locking arrangements for rotary powered surgical instruments |
| 9078653, | Mar 26 2012 | Cilag GmbH International | Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge |
| 9084606, | Jun 01 2012 | MEGADYNE MEDICAL PRODUCTS, INC | Electrosurgical scissors |
| 9089360, | Aug 06 2008 | Cilag GmbH International | Devices and techniques for cutting and coagulating tissue |
| 9095362, | Nov 15 2010 | Intuitive Surgical Operations, Inc | Method for passively decoupling torque applied by a remote actuator into an independently rotating member |
| 9095367, | Oct 22 2012 | Cilag GmbH International | Flexible harmonic waveguides/blades for surgical instruments |
| 9101374, | Aug 07 2012 | Method for guiding an ablation catheter based on real time intracardiac electrical signals and apparatus for performing the method | |
| 9106270, | Oct 02 2012 | Covidien LP | Transmitting data across a patient isolation barrier using an electric-field capacitive coupler module |
| 9107573, | Oct 17 2012 | KARL STORZ Endovision, Inc. | Detachable shaft flexible endoscope |
| 9107684, | Mar 05 2010 | Covidien LP | System and method for transferring power to intrabody instruments |
| 9107688, | Sep 12 2008 | Cilag GmbH International | Activation feature for surgical instrument with pencil grip |
| 9107694, | Jan 30 2009 | Koninklijke Philips Electronics N V | Examination apparatus |
| 9114494, | Mar 14 2013 | Electronic drill guide | |
| 9119657, | Jun 28 2012 | Cilag GmbH International | Rotary actuatable closure arrangement for surgical end effector |
| 9123155, | Aug 09 2011 | Covidien LP | Apparatus and method for using augmented reality vision system in surgical procedures |
| 9138129, | Jun 13 2007 | Intuitive Surgical Operations, Inc. | Method and system for moving a plurality of articulated instruments in tandem back towards an entry guide |
| 9161803, | Nov 05 2010 | Cilag GmbH International | Motor driven electrosurgical device with mechanical and electrical feedback |
| 9168054, | Oct 09 2009 | Cilag GmbH International | Surgical generator for ultrasonic and electrosurgical devices |
| 9183723, | Jan 31 2012 | CLEAN ALERT INNOVATIONS, LLC | Filter clog detection and notification system |
| 9192707, | Apr 29 2011 | Mozarc Medical US LLC | Electrolyte and pH monitoring for fluid removal processes |
| 9204879, | Jun 28 2012 | Cilag GmbH International | Flexible drive member |
| 9216062, | Feb 15 2012 | Intuitive Surgical Operations, Inc | Seals and sealing methods for a surgical instrument having an articulated end effector actuated by a drive shaft |
| 9218053, | Aug 04 2011 | Olympus Corporation | Surgical assistant system |
| 9220502, | Dec 28 2011 | Covidien LP | Staple formation recognition for a surgical device |
| 9226766, | Apr 09 2012 | Cilag GmbH International | Serial communication protocol for medical device |
| 9241728, | Mar 15 2013 | Cilag GmbH International | Surgical instrument with multiple clamping mechanisms |
| 9241731, | Apr 09 2012 | Cilag GmbH International | Rotatable electrical connection for ultrasonic surgical instruments |
| 9250172, | Sep 21 2012 | Ethicon Endo-Surgery, Inc | Systems and methods for predicting metabolic and bariatric surgery outcomes |
| 9265585, | Oct 23 2012 | Covidien LP | Surgical instrument with rapid post event detection |
| 9277956, | Nov 09 2011 | PIXART IMAGING INC | System for automatic medical ablation control |
| 9280884, | Sep 03 2014 | Oberon, Inc. | Environmental sensor device with alarms |
| 9282974, | Jun 28 2012 | Cilag GmbH International | Empty clip cartridge lockout |
| 9283054, | Aug 23 2013 | Cilag GmbH International | Interactive displays |
| 9289212, | Sep 17 2010 | Cilag GmbH International | Surgical instruments and batteries for surgical instruments |
| 9295514, | Aug 30 2013 | Cilag GmbH International | Surgical devices with close quarter articulation features |
| 9301691, | Feb 21 2014 | Covidien LP | Instrument for optically detecting tissue attributes |
| 9301753, | Sep 30 2010 | Cilag GmbH International | Expandable tissue thickness compensator |
| 9307914, | Apr 15 2011 | INFOBIONIC, INC | Remote data monitoring and collection system with multi-tiered analysis |
| 9307986, | Mar 01 2013 | Cilag GmbH International | Surgical instrument soft stop |
| 9314246, | Sep 30 2010 | Cilag GmbH International | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
| 9314308, | Mar 13 2013 | Cilag GmbH International | Robotic ultrasonic surgical device with articulating end effector |
| 9331422, | Jun 09 2014 | Apple Inc. | Electronic device with hidden connector |
| 9332987, | Mar 14 2013 | Cilag GmbH International | Control arrangements for a drive member of a surgical instrument |
| 9345481, | Mar 13 2013 | Cilag GmbH International | Staple cartridge tissue thickness sensor system |
| 9345490, | Feb 04 2009 | STRYKER EUROPEAN HOLDINGS III, LLC | Surgical power tool and actuation assembly therefor |
| 9358685, | Feb 03 2014 | Brain Corporation | Apparatus and methods for control of robot actions based on corrective user inputs |
| 9364231, | Oct 27 2011 | Covidien LP | System and method of using simulation reload to optimize staple formation |
| 9364294, | Feb 17 2009 | InnerOptic Technology, Inc. | Systems, methods, apparatuses, and computer-readable media for image management in image-guided medical procedures |
| 9375282, | Mar 26 2012 | Covidien LP | Light energy sealing, cutting and sensing surgical device |
| 9381003, | Mar 23 2012 | Integrated Medical Systems International, Inc. | Digital controller for surgical handpiece |
| 9393017, | Feb 15 2011 | Intuitive Surgical Operations, Inc | Methods and systems for detecting staple cartridge misfire or failure |
| 9398905, | Dec 13 2012 | Cilag GmbH International | Circular needle applier with offset needle and carrier tracks |
| 9398911, | Mar 01 2013 | Cilag GmbH International | Rotary powered surgical instruments with multiple degrees of freedom |
| 9419018, | May 30 2014 | Semiconductor Energy Laboratory Co., Ltd. | Semiconductor device and method for manufacturing the same |
| 9480492, | Oct 25 2011 | Covidien LP | Apparatus for endoscopic procedures |
| 9492146, | Oct 25 2011 | Covidien LP | Apparatus for endoscopic procedures |
| 9492237, | May 19 2006 | MAKO SURGICAL CORP | Method and apparatus for controlling a haptic device |
| 9516239, | Jul 26 2012 | DEPUY SYNTHES PRODUCTS, INC | YCBCR pulsed illumination scheme in a light deficient environment |
| 9526407, | Apr 25 2008 | KARL STORZ IMAGING, INC | Wirelessly powered medical devices and instruments |
| 9526587, | Dec 31 2008 | Intuitive Surgical Operations, Inc | Fiducial marker design and detection for locating surgical instrument in images |
| 9554854, | Mar 18 2014 | Cilag GmbH International | Detecting short circuits in electrosurgical medical devices |
| 9561038, | Jun 28 2012 | Cilag GmbH International | Interchangeable clip applier |
| 9561045, | Jun 13 2006 | Intuitive Surgical Operations, Inc | Tool with rotation lock |
| 9572592, | May 31 2012 | Cilag GmbH International | Surgical instrument with orientation sensing |
| 9629629, | Mar 14 2013 | Cilag GmbH International | Control systems for surgical instruments |
| 9630318, | Oct 02 2014 | Brain Corporation | Feature detection apparatus and methods for training of robotic navigation |
| 9641596, | Jan 25 2012 | PANASONIC INTELLECTUAL PROPERTY MANAGEMENT CO , LTD | Home appliance information management apparatus, home appliance information sharing method, and home appliance information sharing system |
| 9641815, | Mar 15 2013 | DEPUY SYNTHES PRODUCTS, INC | Super resolution and color motion artifact correction in a pulsed color imaging system |
| 9655616, | Jan 22 2014 | Covidien LP | Apparatus for endoscopic procedures |
| 9662177, | Feb 15 2011 | Intuitive Surgical Operations, Inc. | Methods and systems for indicating a clamping prediction |
| 9668729, | Mar 13 2013 | Covidien LP | Surgical stapling apparatus |
| 9686306, | Nov 02 2012 | University of Washington Through Its Center for Commercialization | Using supplemental encrypted signals to mitigate man-in-the-middle attacks on teleoperated systems |
| 9700309, | Mar 01 2013 | Cilag GmbH International | Articulatable surgical instruments with conductive pathways for signal communication |
| 9710644, | Sep 05 2014 | ServiceNow, Inc | Techniques for sharing network security event information |
| 9717498, | Mar 13 2013 | Covidien LP | Surgical stapling apparatus |
| 9717548, | Sep 24 2013 | Covidien LP | Electrode for use in a bipolar electrosurgical instrument |
| 9724118, | Apr 09 2012 | Cilag GmbH International | Techniques for cutting and coagulating tissue for ultrasonic surgical instruments |
| 9737301, | Sep 05 2014 | Cilag GmbH International | Monitoring device degradation based on component evaluation |
| 9737310, | Jul 28 2010 | Covidien LP | Articulating clip applier |
| 9737335, | Aug 08 2002 | Atropos Limited | Device |
| 9743016, | Dec 10 2012 | Intel Corporation | Techniques for improved focusing of camera arrays |
| 9743946, | Dec 17 2013 | Cilag GmbH International | Rotation features for ultrasonic surgical instrument |
| 9743947, | Mar 15 2013 | Cilag GmbH International | End effector with a clamp arm assembly and blade |
| 9750522, | Aug 15 2013 | Cilag GmbH International | Surgical instrument with clips having transecting blades |
| 9750523, | Feb 17 2014 | Olympus Corporation | Ultrasonic treatment apparatus |
| 9757128, | Sep 05 2014 | Cilag GmbH International | Multiple sensors with one sensor affecting a second sensor's output or interpretation |
| 9757142, | Aug 09 2006 | Olympus Corporation | Relay device and ultrasonic-surgical and electrosurgical system |
| 9764164, | Jul 15 2009 | Cilag GmbH International | Ultrasonic surgical instruments |
| 9777913, | Mar 15 2013 | DEPUY SYNTHES PRODUCTS, INC | Controlling the integral light energy of a laser pulse |
| 9782164, | Jun 16 2015 | Cilag GmbH International | Suturing instrument with multi-mode cartridges |
| 9782169, | Mar 01 2013 | Cilag GmbH International | Rotary powered articulation joints for surgical instruments |
| 9782212, | Dec 02 2014 | Covidien LP | High level algorithms |
| 9782214, | Nov 05 2010 | Cilag GmbH International | Surgical instrument with sensor and powered control |
| 9788851, | Apr 18 2012 | Cilag GmbH International | Surgical instrument with tissue density sensing |
| 9788907, | Feb 28 2017 | DIGITAL SURGERY LIMITED | Automated provision of real-time custom procedural surgical guidance |
| 9795436, | Jan 07 2014 | Cilag GmbH International | Harvesting energy from a surgical generator |
| 9801679, | Jan 28 2014 | Cilag GmbH International | Methods and devices for controlling motorized surgical devices |
| 9805472, | Feb 18 2015 | Sony Corporation | System and method for smoke detection during anatomical surgery |
| 9808244, | Mar 14 2013 | Cilag GmbH International | Sensor arrangements for absolute positioning system for surgical instruments |
| 9808245, | Dec 13 2013 | Covidien LP | Coupling assembly for interconnecting an adapter assembly and a surgical device, and surgical systems thereof |
| 9808246, | Mar 06 2015 | Cilag GmbH International | Method of operating a powered surgical instrument |
| 9814460, | Apr 16 2013 | Cilag GmbH International | Modular motor driven surgical instruments with status indication arrangements |
| 9814462, | Sep 30 2010 | Cilag GmbH International | Assembly for fastening tissue comprising a compressible layer |
| 9814463, | Mar 13 2013 | Covidien LP | Surgical stapling apparatus |
| 9820741, | May 12 2011 | Covidien LP | Replaceable staple cartridge |
| 9826976, | Apr 16 2013 | Cilag GmbH International | Motor driven surgical instruments with lockable dual drive shafts |
| 9839419, | Jun 16 2015 | Cilag GmbH International | Suturing instrument with jaw having integral cartridge component |
| 9839424, | Jan 17 2014 | Covidien LP | Electromechanical surgical assembly |
| 9839428, | Dec 23 2013 | Cilag GmbH International | Surgical cutting and stapling instruments with independent jaw control features |
| 9839470, | Jun 30 2015 | Covidien LP | Electrosurgical generator for minimizing neuromuscular stimulation |
| 9839487, | Mar 17 2014 | Intuitive Surgical Operations, Inc.; Intuitive Surgical Operations, Inc | Backup latch release for surgical instrument |
| 9844375, | Dec 18 2014 | Cilag GmbH International | Drive arrangements for articulatable surgical instruments |
| 9861354, | May 06 2011 | CETERIX ORTHOPAEDICS, INC | Meniscus repair |
| 9867612, | Apr 16 2013 | Cilag GmbH International | Powered surgical stapler |
| 9867651, | Sep 26 2013 | Covidien LP | Systems and methods for estimating tissue parameters using surgical devices |
| 9872683, | Mar 14 2013 | Applied Medical Resources Corporation | Surgical stapler with partial pockets |
| 9877718, | Feb 15 2011 | Intuitive Surgical Operations, Inc. | Methods and systems for detecting clamping or firing failure |
| 9888914, | Jun 16 2015 | Cilag GmbH International | Suturing instrument with motorized needle drive |
| 9895148, | Mar 06 2015 | Cilag GmbH International | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
| 9901342, | Mar 06 2015 | Cilag GmbH International | Signal and power communication system positioned on a rotatable shaft |
| 9905000, | Feb 19 2015 | Sony Corporation | Method and system for surgical tool localization during anatomical surgery |
| 9907550, | Jan 27 2014 | Covidien LP | Stitching device with long needle delivery |
| 9918778, | May 02 2006 | Aesculap AG | Laparoscopic radiofrequency surgical device |
| 9918788, | Oct 31 2012 | ST JUDE MEDICAL, ATRIAL FIBRILLATION DIVISION, INC | Electrogram-based ablation control |
| 9924941, | Oct 26 2011 | Intuitive Surgical Operations, Inc | Surgical instrument with integral knife blade |
| 9931118, | Feb 27 2015 | Cilag GmbH International | Reinforced battery for a surgical instrument |
| 9931124, | Jan 07 2015 | Covidien LP | Reposable clip applier |
| 9936955, | Jan 11 2011 | AMSEL MEDICAL CORPORATION | Apparatus and methods for fastening tissue layers together with multiple tissue fasteners |
| 9937012, | Mar 07 2014 | CMR Surgical Limited | Surgical arm |
| 9937626, | Dec 11 2013 | Covidien LP | Wrist and jaw assemblies for robotic surgical systems |
| 9938972, | Aug 19 2013 | FISH ENGINEERING LIMITED | Distributor apparatus with a pair of intermeshing screw rotors |
| 9943918, | May 16 2014 | Powdermet, Inc. | Heterogeneous composite bodies with isolated cermet regions formed by high temperature, rapid consolidation |
| 9949785, | Nov 21 2013 | Cilag GmbH International | Ultrasonic surgical instrument with electrosurgical feature |
| 9980778, | Mar 07 2003 | Intuitive Surgical Operations, Inc. | Instrument having radio frequency identification systems and methods for use |
| 20020049551, | |||
| 20050149356, | |||
| 20060020272, | |||
| 20060241399, | |||
| 20070016235, | |||
| 20070027459, | |||
| 20070168461, | |||
| 20070225556, | |||
| 20070249990, | |||
| 20070270660, | |||
| 20070293218, | |||
| 20080015664, | |||
| 20080040151, | |||
| 20080059658, | |||
| 20080255413, | |||
| 20080296346, | |||
| 20090036794, | |||
| 20090043253, | |||
| 20090046146, | |||
| 20090076409, | |||
| 20090099866, | |||
| 20090259149, | |||
| 20090259221, | |||
| 20100198248, | |||
| 20110118708, | |||
| 20110121049, | |||
| 20110306840, | |||
| 20120130217, | |||
| 20120209314, | |||
| 20120211542, | |||
| 20130046279, | |||
| 20130105552, | |||
| 20130116218, | |||
| 20130165776, | |||
| 20130214025, | |||
| 20130253480, | |||
| 20130256373, | |||
| 20130317837, | |||
| 20130321425, | |||
| 20130325809, | |||
| 20130331874, | |||
| 20130331875, | |||
| 20140006132, | |||
| 20140006943, | |||
| 20140035762, | |||
| 20140066700, | |||
| 20140081255, | |||
| 20140081659, | |||
| 20140087999, | |||
| 20140092089, | |||
| 20140107697, | |||
| 20140128885, | |||
| 20140171923, | |||
| 20140204190, | |||
| 20140263541, | |||
| 20140263552, | |||
| 20150032150, | |||
| 20150051617, | |||
| 20150053737, | |||
| 20150066000, | |||
| 20150122870, | |||
| 20150257816, | |||
| 20150272557, | |||
| 20150297200, | |||
| 20150302157, | |||
| 20150317899, | |||
| 20150374369, | |||
| 20160000437, | |||
| 20160095585, | |||
| 20160166256, | |||
| 20160192960, | |||
| 20160199125, | |||
| 20160220253, | |||
| 20160235303, | |||
| 20160253472, | |||
| 20160256071, | |||
| 20160256154, | |||
| 20160270780, | |||
| 20160296246, | |||
| 20160310055, | |||
| 20160310203, | |||
| 20160321400, | |||
| 20160323283, | |||
| 20160324537, | |||
| 20160374665, | |||
| 20160374723, | |||
| 20160374762, | |||
| 20170000516, | |||
| 20170000553, | |||
| 20170000554, | |||
| 20170020291, | |||
| 20170021507, | |||
| 20170056017, | |||
| 20170056116, | |||
| 20170061375, | |||
| 20170086829, | |||
| 20170086910, | |||
| 20170086911, | |||
| 20170086914, | |||
| 20170086930, | |||
| 20170105754, | |||
| 20170132785, | |||
| 20170151026, | |||
| 20170164997, | |||
| 20170165012, | |||
| 20170171231, | |||
| 20170172553, | |||
| 20170172614, | |||
| 20170172672, | |||
| 20170181745, | |||
| 20170189093, | |||
| 20170196637, | |||
| 20170202591, | |||
| 20170202592, | |||
| 20170202605, | |||
| 20170202607, | |||
| 20170224428, | |||
| 20170231628, | |||
| 20170238936, | |||
| 20170238991, | |||
| 20170245854, | |||
| 20170249432, | |||
| 20170252095, | |||
| 20170281173, | |||
| 20170281189, | |||
| 20170290586, | |||
| 20170296169, | |||
| 20170296173, | |||
| 20170296177, | |||
| 20170296179, | |||
| 20170296185, | |||
| 20170296189, | |||
| 20170296213, | |||
| 20170319265, | |||
| 20170325903, | |||
| 20170340345, | |||
| 20170354470, | |||
| 20170367754, | |||
| 20180008359, | |||
| 20180014848, | |||
| 20180049817, | |||
| 20180049820, | |||
| 20180055529, | |||
| 20180064498, | |||
| 20180071693, | |||
| 20180098816, | |||
| 20180110523, | |||
| 20180110576, | |||
| 20180122506, | |||
| 20180140366, | |||
| 20180153574, | |||
| 20180153628, | |||
| 20180153632, | |||
| 20180161716, | |||
| 20180168747, | |||
| 20180168748, | |||
| 20180168759, | |||
| 20180177557, | |||
| 20180238776, | |||
| 20180243035, | |||
| 20180250080, | |||
| 20180250084, | |||
| 20180263710, | |||
| 20180263717, | |||
| 20180271603, | |||
| 20180296286, | |||
| 20180296291, | |||
| 20180310986, | |||
| 20180310997, | |||
| 20180317915, | |||
| 20180358112, | |||
| 20180360449, | |||
| 20180360452, | |||
| 20180360454, | |||
| 20180360456, | |||
| 20190000446, | |||
| 20190000448, | |||
| 20190000465, | |||
| 20190000478, | |||
| 20190000530, | |||
| 20190000565, | |||
| 20190006047, | |||
| 20190008600, | |||
| 20190029712, | |||
| 20190038364, | |||
| 20190053801, | |||
| 20190053866, | |||
| 20190069949, | |||
| 20190069964, | |||
| 20190090969, | |||
| 20190099180, | |||
| 20190099227, | |||
| 20190104919, | |||
| 20190125320, | |||
| 20190125321, | |||
| 20190125324, | |||
| 20190125335, | |||
| 20190125336, | |||
| 20190125337, | |||
| 20190125338, | |||
| 20190125339, | |||
| 20190125347, | |||
| 20190125348, | |||
| 20190125352, | |||
| 20190125353, | |||
| 20190125354, | |||
| 20190125355, | |||
| 20190125356, | |||
| 20190125357, | |||
| 20190125358, | |||
| 20190125359, | |||
| 20190125360, | |||
| 20190125361, | |||
| 20190125365, | |||
| 20190125377, | |||
| 20190125378, | |||
| 20190125379, | |||
| 20190125381, | |||
| 20190125382, | |||
| 20190125383, | |||
| 20190125384, | |||
| 20190125385, | |||
| 20190125386, | |||
| 20190125387, | |||
| 20190125388, | |||
| 20190125389, | |||
| 20190125390, | |||
| 20190125430, | |||
| 20190125431, | |||
| 20190125432, | |||
| 20190125454, | |||
| 20190125455, | |||
| 20190125456, | |||
| 20190125457, | |||
| 20190125458, | |||
| 20190125459, | |||
| 20190125476, | |||
| 20190133703, | |||
| 20190142449, | |||
| 20190142535, | |||
| 20190145942, | |||
| 20190150975, | |||
| 20190159778, | |||
| 20190162179, | |||
| 20190192236, | |||
| 20190200844, | |||
| 20190200863, | |||
| 20190200905, | |||
| 20190200906, | |||
| 20190200977, | |||
| 20190200980, | |||
| 20190200981, | |||
| 20190200984, | |||
| 20190200985, | |||
| 20190200986, | |||
| 20190200987, | |||
| 20190200988, | |||
| 20190200996, | |||
| 20190200997, | |||
| 20190200998, | |||
| 20190201018, | |||
| 20190201020, | |||
| 20190201021, | |||
| 20190201023, | |||
| 20190201024, | |||
| 20190201025, | |||
| 20190201026, | |||
| 20190201027, | |||
| 20190201028, | |||
| 20190201029, | |||
| 20190201030, | |||
| 20190201033, | |||
| 20190201034, | |||
| 20190201036, | |||
| 20190201037, | |||
| 20190201038, | |||
| 20190201039, | |||
| 20190201040, | |||
| 20190201041, | |||
| 20190201042, | |||
| 20190201043, | |||
| 20190201044, | |||
| 20190201045, | |||
| 20190201046, | |||
| 20190201047, | |||
| 20190201073, | |||
| 20190201074, | |||
| 20190201075, | |||
| 20190201077, | |||
| 20190201079, | |||
| 20190201080, | |||
| 20190201081, | |||
| 20190201082, | |||
| 20190201083, | |||
| 20190201084, | |||
| 20190201085, | |||
| 20190201086, | |||
| 20190201087, | |||
| 20190201088, | |||
| 20190201090, | |||
| 20190201091, | |||
| 20190201092, | |||
| 20190201102, | |||
| 20190201104, | |||
| 20190201105, | |||
| 20190201111, | |||
| 20190201112, | |||
| 20190201113, | |||
| 20190201114, | |||
| 20190201115, | |||
| 20190201116, | |||
| 20190201117, | |||
| 20190201118, | |||
| 20190201119, | |||
| 20190201120, | |||
| 20190201122, | |||
| 20190201123, | |||
| 20190201124, | |||
| 20190201125, | |||
| 20190201126, | |||
| 20190201127, | |||
| 20190201128, | |||
| 20190201129, | |||
| 20190201130, | |||
| 20190201135, | |||
| 20190201136, | |||
| 20190201137, | |||
| 20190201138, | |||
| 20190201139, | |||
| 20190201140, | |||
| 20190201141, | |||
| 20190201142, | |||
| 20190201143, | |||
| 20190201144, | |||
| 20190201145, | |||
| 20190201146, | |||
| 20190201158, | |||
| 20190201159, | |||
| 20190201593, | |||
| 20190201594, | |||
| 20190201597, | |||
| 20190204201, | |||
| 20190205001, | |||
| 20190205441, | |||
| 20190205566, | |||
| 20190205567, | |||
| 20190206003, | |||
| 20190206004, | |||
| 20190206050, | |||
| 20190206216, | |||
| 20190206542, | |||
| 20190206551, | |||
| 20190206555, | |||
| 20190206556, | |||
| 20190206561, | |||
| 20190206562, | |||
| 20190206563, | |||
| 20190206564, | |||
| 20190206565, | |||
| 20190206569, | |||
| 20190206576, | |||
| 20190207773, | |||
| 20190207857, | |||
| 20190207911, | |||
| 20190208641, | |||
| 20190223291, | |||
| 20190274662, | |||
| 20190274705, | |||
| 20190274706, | |||
| 20190274707, | |||
| 20190274708, | |||
| 20190274709, | |||
| 20190274710, | |||
| 20190274711, | |||
| 20190274712, | |||
| 20190274713, | |||
| 20190274714, | |||
| 20190274716, | |||
| 20190274717, | |||
| 20190274718, | |||
| 20190274719, | |||
| 20190274720, | |||
| 20190274749, | |||
| 20190274750, | |||
| 20190274752, | |||
| 20190290389, | |||
| 20190298340, | |||
| 20190298341, | |||
| 20190298342, | |||
| 20190298343, | |||
| 20190298346, | |||
| 20190298347, | |||
| 20190298350, | |||
| 20190298351, | |||
| 20190298352, | |||
| 20190298353, | |||
| 20190298354, | |||
| 20190298355, | |||
| 20190298356, | |||
| 20190298357, | |||
| 20190298481, | |||
| 20190307520, | |||
| AU2015201140, | |||
| CA2795323, | |||
| CN101617950, | |||
| CN104490448, | |||
| CN206097107, | |||
| D399561, | Jan 24 1991 | Megadyne Medical Products, Inc. | Electrical surgical forceps handle |
| DE102005051367, | |||
| DE102016207666, | |||
| DE3824913, | |||
| DE4002843, | |||
| EP756, | |||
| EP3047806, | |||
| EP3056923, | |||
| EP3095399, | |||
| EP3141181, | |||
| GB2509523, | |||
| JP2017513561, | |||
| JP5373315, | |||
| KR101587721, | |||
| KR20140104587, | |||
| WO24322, | |||
| WO108578, | |||
| WO112089, | |||
| WO120892, | |||
| WO2007137304, | |||
| WO2008056618, | |||
| WO2008069816, | |||
| WO2011112931, | |||
| WO2013143573, | |||
| WO2015129395, | |||
| WO2016206015, | |||
| WO2017011382, | |||
| WO2017151996, | |||
| WO2017189317, | |||
| WO2017205308, | |||
| WO2017210499, | |||
| WO2017210501, | |||
| WO2018152141, | |||
| WO9734533, |
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